Tag: High FVOD

Beyond the Screening Rules: How Collateral Data Clarifies Complex SASSI Profiles

This very unusual profile was called in to our Clinical Helpline Staff and provides us the opportunity to discuss several key issues with regard to clinical interpretation of individual SASSI scale raw scores:

  1. It is critical to gather additional information beyond the SASSI from reliable sources and then integrate this information with the basic foundational scale interpretations provided by our case study research;
  2. When highly unusual scale scores occur, seemingly contradicting one another, resist the temptation to over-interpret and;
  3. Notice when scale score interpretations suggest potential problem areas beyond just the substance use disorder issues and make a plan to address these.   

This client profile is a clear example of the need for additional clarifying information about the client. The only information we were given was the client’s biological sex (female) and their age (25 years old). What makes this profile confusing is that the individual scale scores sharply deviate from “normal” scoring patterns in a few places, which leads to scale interpretations that seem to contradict one another. For example, the client has clearly acknowledged that she has had or is having significant negative consequences, problems or trouble as a result of her use of both alcohol and other drugs (FVA=23 and FVOD=30) and therefore may have lost control of her use and may be using as a coping mechanism. These scores are extremely high compared to the general population and typically leave no doubt that this person has most certainly crossed the line into substance addiction and is quite willing and able to recognize and admit the severe consequences her substance mis-use has caused in her life.  This is further confirmed by an extremely high OAT scale score of 8 which would generally be interpreted to mean that this person greatly identifies with many of the usual negative attributes or personal limitations/weaknesses that are common among those with active substance use disorders (e.g. impatience, resentment, self-pity, impulsiveness, restlessness) and usually, if asked, would readily admit to sharing many similarities with those who have substance problems. Lastly, her SAT scale score is also extremely high, once again strongly indicating a person with a significant substance problem.

But there are other scale scores which seem to contradict some of these basic interpretations. For example, the client has a DEF score of 11 which is far above the 98th percentile and suggests that the client is answering the questions in such a way on this scale that would indicate someone who would tend to not share anything about herself that would put them in a bad light or show weakness or vulnerability. DEF scores like this usually tend to suggest a client who wants to appear as if they have it altogether as they are endorsing only positives about themselves. How can this be true though if their FVA/FVOD and OAT scale scores are so high that they strongly indicate a person who is able to admit and acknowledge numerous negative consequences from substance mis-use and is able to strongly identify with many of the same negative attributes or weaknesses that are often found in those with active substance disorders? In addition to that, how can this client have such extremely high scores on FVA and FVOD and yet have a relatively normal score of 4 on the SYM scale? The SYM scale, like the FVA/FVOD scales, is also a very obvious, face valid set of questions about problems with substance use and yet her score on the SYM seems to indicate relatively none of the typical symptoms we would associate with one struggling with a SUD. One possible reason for the discrepancy between the scores on the FVA/FVOD scales and those on the SYM scale would be because of the timeframe that the client was asked to use in answering the FVA/FVOD scale questions. Unfortunately, we were not given this information about this client profile, but if the client was asked to answer the FVA/FVOD questions based on their entire life, then the scores could be quite high but be representative of a time in the distant past. Since the T/F questions have no specific timeframe associated with them, the client may have answered the SYM questions based on a more recent timeframe in which they had achieved some level of sobriety.

Even the extremely high SAT score seems a bit contradictory with other scale scores since usually a high SAT score would indicate someone who is not able to admit or acknowledge that they have a substance problem. However, since the SAT score was positioned higher on the graph then the OAT scale score, our research suggests that individuals with that type of scoring pattern are sometimes able to admit to the very obvious consequences of their substance misuse (when OAT and Face Valid scale scores are high like this client) and may even be able at times to self-identify to a certain extent with certain obvious behavior patterns that often lead to substance misuse. However, people with very high SAT scores, and especially ones that are higher on the graph then the OAT score, are often not able to see the deeper, underlying, less conscious issues that are constantly plaguing them and significantly influencing their substance misuse behaviors in a much more covert way. They often simply cannot see the pervasive nature of the disease acting in their everyday life. They often are emotionally avoidant and superficially may believe that their substance problems are just a set of bad habits that they can stop on their own. They see the physical manifestations of the problem, but are unable or unwilling to see the emotional and spiritual aspects of the problem. They often will actively avoid treatment that involves examining their negative thought patterns, deeply held negative beliefs, fears, and other deeply rooted issues that have a stranglehold on their life and behaviors. Some of these clients will incorrectly assume that their substance problems only reside with their use of the “hard” drugs and if they just quit using those, then they can continue to drink and smoke marijuana and all will be well.

This explanation actually helps us to better interpret the client’s very high DEF score as well. While the client is able to admit and acknowledge having a lot of problems and trouble as a result of her use of alcohol and other drugs as seen in her very high FVA, FVOD, and OAT scores, her very high SAT and DEF scores show that her admission and acknowledgement is only at a very surface level. In other words, she admits all the things that are pretty much already part of the public record and everyone knows about, but the problem is much deeper than that and she is oblivious to how deep and pervasive it really is. This is what we would call a sincere delusion. She admits what she is aware of and what she feels she has control over. But there is much more beneath the surface that she can’t see. Her defensiveness is potentially a way for her to demonstrate that she’s in control, that there’s nothing to see here and everyone should move on. Like her very high SAT score implies, she may be unable to identify or get in touch with her real emotions and pain and she may have situational reasons or life experiences which have taught her to not let people see her flaws or weaknesses, the real her. She will tend to focus away from internal processes and look instead at tasks and factors outside of herself. This increases the likelihood that she may put herself at risk without awareness of her own vulnerability.  She will be more likely to find excuses not to engage in treatment and recovery activities, especially if she is able to achieve short spurts of sobriety. Once the challenge of proving she can abstain from alcohol or drugs for a short time loses its luster or crises arise that she cannot cope with on the basis of her more superficial focus, she will be more likely to relapse.

The risk of relapse is particularly increased given her similarity to others who violate cultural norms sufficiently to have repeated involvement with the criminal justice system, as evidenced by her elevated COR scale score (COR=12). In addition, the elevated COR score suggests increased risk for future criminal behavior independent of the client’s substance use or mis-use. A comprehensive assessment of underlying risk factors in the client such as poor social skills, anger management issues, poor impulse control or low frustration tolerance would be a valuable exercise so that, if any of these issues are uncovered, an effective treatment plan that specifically addresses these issues could be developed to potentially decrease the risk of repeated involvement with the criminal justice system.

In summary, this young woman’s profile indicates three problem areas that need to be the focus of potential treatment: her substance use disorder (if diagnosed), her defensiveness, and her risk for legal problems. This client meets SASSI Decision Rules indicating a high probability of a substance use disorder. While the SASSI does not specifically provide a prediction of the level of the disorder (i.e. mild, moderate or severe), typically clients with FVA/FVOD, OAT and SAT scores as high as this client’s often have moderate to severe disorders if the disorder is active. The scores also suggest a pattern of addictive behaviors that have a pervasive influence on her life, which she is not likely able to fully recognize or accept. She most likely has little or no self-awareness with regard to her underlying emotional pain and may tend to shift responsibility or blame to her life situation and/or other people.

In light of this, she will most likely resist many conventional forms of treatment and prefer to “fix it” herself. There is a high risk of premature self-labeling as “cured” after one or two successful short attempts at sobriety, ultimately resulting in full blown relapse.  The risk of future criminal behavior is high, suggesting that compliance with other rules may also be problematic. Further assessment and/or building in a specific treatment focus on this risk through cognitive-behavioral interventions would be reasonable options to consider.

In trying to interpret the individual scale scores for this client, one can see that, while the foundational interpretations that normally apply to certain scoring patterns certainly can lead us in the right direction, without more data from other reliable sources, one can only speculate as to why some of the standard scale score interpretations initially seem to be in contradiction with one another. With more information from collateral sources (family, teacher, employer, coach, friends, etc.), naturally occurring records (e.g. arrests, ER visits, prior treatments, etc.) or behavioral records (work behavior, school behavior), we could more easily narrow down, shape and confirm or deny our initial interpretations.

Getting additional information from other sources also can help us to resist over-interpreting. In the absence of clear information, one is more likely to speculate. While no SASSI interpretations are ever meant to be considered absolute, we can nevertheless trust that the foundational interpretations which came from our case study research have proven to be quite reliable and accurate in most cases. But when individual scale score interpretations seem to clash, we have to resist making up information and therefore over-interpreting or mis-interpreting and instead gather actual data that could more correctly resolve the perceived conflicts.

And finally, spend time learning and practicing how to utilize the SASSI foundational scale score interpretations in combination with other reliable sources to identify and address any other non-substance-specific challenges facing the client. These could range from defensiveness and high risk of involvement in the criminal justice system like this client to possible depression, suicidal ideation, or typical symptoms associated with co-dependency. While the SASSI’s primary function is not that of a depression, suicide risk or co-dependency screening, basic scale score interpretation can provide clinicians with a “heads up” on the possibility of these and other issues, prompting the clinician to do further evaluation in these areas and develop treatment plans, educational resources and/or referral plans to address them.

To become more familiar with clinical interpretation, we invite you to attend one of our training sessions taught by a SASSI-certified trainer ( https://sassi.com/sassi-training/) and/or to utilize our free Clinical Helpline at 1-888-297-2774 which is available Monday – Friday from 1:00pm – 5:00pm EST to assist clinicians in learning how to interpret their client’s results better.   

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

The following profile result is of a 35-year-old male referred for screening and possible assessment after a drug-related arrest. He completed the FVA/FVOD side of the questionnaire based on his entire life timeframe. His RAP score was 0, indicating no random responding and that the result should be valid. His Prescription Drug Scale score (Rx) was 1, so he did not meet the cutoff for High Probability of Prescription Drug Abuse.

Looking at this profile, we see that he was classified as high probability of a substance use disorder based on the following Decision Rules:

  • Decision Rule 1 with a FVOD score of 32.
  • Decision Rule 3 with an OAT score of 9.
  • Decision Rule 4 with a SAT score of 14.
  • Decision Rule 5 with a SYM score of 6 (5 or more) and a SAT score of 14 (4 or more).
  • Decision Rule 7 with an OAT score of 9 (7 or more) and a SAT score of 14 (6 or more).

Looking at the graph on the SASSI Adult Male Profile sheet, we see an extremely high elevation on the FVOD scale score which is significantly above the 98th percentile. Individuals who score this high on the FVOD are able to acknowledge currently having or having had numerous negative consequences and problems as a result of their use of drugs. This can include loss of control of the drug use as well as using a coping mechanism.  It is important to note that, since he was asked to use the “entire life” timeframe for the FVA and FVOD scales, his admission of having these consequences and problems with drugs may be related to some time in his past and not necessarily currently. For example, the client’s score on the SYM scale (which is similar to the FVA/FVOD in what it is measuring), is not nearly as elevated as his score on the FVOD even though the questions are not that dissimilar from the FVOD questions.

This suggests that he is not showing as much acknowledgement on the SYM scale of the symptoms of substance misuse that he admitted to on the FVOD scale. This could be related to the fact that the SYM scale (like all scales on the True/False side of the questionnaire) has no specific timeframe associated with it and therefore the client may have the belief that, while he has had significant problems with drugs in the past, he may not believe his current drug use is as much of a problem currently. It is highly recommended that clinicians do a content analysis of the client’s answers to the FVOD and SYM scale questions as this will provide more insight into the client’s acknowledged problems with drugs.   

This client’s elevated OAT scale score, like the elevated FVOD scale score, suggests a capacity to acknowledge and identify with many of the typical negative attributes (general personality and behavioral characteristics) and personal limitations that are often common among those with substance use disorders – e.g. impatience, resentment, self-pity, impulsiveness).  While the client can often see these “character defects”, they may not always feel motivated to change them or feel capable of changing. Given that the OAT score in this case is above the 98th percentile, it is highly probable that this individual may be able to closely identify with individuals in recovery from substance use disorder, such as those found at recovery support groups, and therefore may be more willing to trust these recovering individuals and follow their recovery advice.

The client’s highly elevated SAT score (the highest score on this profile), which is higher on the graph than the OAT score, suggests that despite the client’s capacity to acknowledge the more obvious problems and negative consequences associated with his use of drugs, there are subtle aspects of his behavior, personality, and addiction that are extremely hard for him to acknowledge. In other words, he may not be able recognize the pervasiveness of his addiction, how it negatively affects and rules every aspect of his life with deeply held negative thinking patterns, beliefs and negative coping patterns driving his addictive behaviors.

Clients with a pattern of scores like this client who tend to be able to acknowledge heavy usage, negative consequences and problem behaviors, may still be convinced, sincerely deluded into thinking that they are not truly addicted. They will often present as more “superficial” saying things like “well, I go to work every day and do my job so I couldn’t be addicted”. Clients with elevated SAT scores (especially higher on the graph than their OAT score) tend to be more initially resistant to the need for treatment and are more likely to relapse. These clients tend to be detached from their feelings and have relatively little insight into the basis and causes of their problems (namely substance addiction). These clients typically need a more intensive level of treatment where they can receive constant support for their recovery efforts and can get the kind of group processing therapy needed to help them connect with their feelings and learn how to cope with them without drugs.

In providing treatment to this type of client it is important to recognize that underneath the many excuses (other than substance addiction) for their problems, there is an individual with a substance use disorder who is likely in pain and scared. Individuals with high SAT scores may not be in touch with the pain and fear, largely because they immediately numb any negative feelings with substances as soon as they appear, but the pain and fear. In this case, intensive treatment and group work has to be accompanied by sensitive and skillful clinical intervention that lets the individual know that somebody is aware of their fear deep within and that it will be a relief to let it out to begin healing.

We hope you find this useful information regarding clinical issues.  As always, the Clinical Helpline at 888-297-2774 is open to serve you Monday through Friday, 9 am to 5 pm (EST).

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Adolescent SASSI-A3 Review: High Probability Result with a VAL of 6

This adolescent male profile presents some initial complications for the reviewer in regards to the clinical interpretation as seen on the graph. The face valid scales fall either within the norm or below the norm. One of the subtle scales is above the 85th percentile so is clinically significant, and another is below the norm. An examination of the scales produces useful information to guide the discussion of the results with the client and directing appropriate treatment considerations.

This 17-year-old male completed the FVA/FVOD side of the questionnaire for his whole lifetime.

The VAL is 6.

Rx Scale is 0.

High Probability of a Substance Use Disorder is based on Rule 6.

Rule 6: a. FVOD 7 or more. (8)

            b. FRISK or ATT or SYM is 3 or more. (SYM – 3).

            c. OAT 5 or more (7).

Clinical Discussion

The FVOD of 8 is above average and should be noted. Examining those particular questions, he endorsed will provide the groundwork for how and under what circumstance he is using drugs. With the FRISK (0) and ATT (1) scores so low, his use is not necessarily tied to his peers, nor does he have a belief or value system that supports the idea that everyone uses substances. Looking at his one ATT score will help to evaluate any beliefs he may hold around substances.

The SYM (3) score is above average and again, because it is a face valid scale, content analysis will provide information regarding the consequences that he does acknowledge.

The OAT (7) scale is significant because it is elevated above the 85th percentile. This is the subtle scale that you want elevated as it indicates someone who can acknowledge limitations and shortcomings. He can probably identify with other substance users and those behaviors represented in that population such as impatience, resentment, self-pity, or impulsiveness. This, of course, does not mean he wants to or believes that he can change. But this information can be used as a positive to recognize the insights he may have around his use.

The low SAT (1) score (below the 15th percentile) gives some clues on how best to approach this client. This score indicates he is very hypersensitive to what others think about him. He may come across as having a chip on his shoulder so tread lightly!

The DEF (8) score, though above average, is still within the norm so does not indicate significant defensiveness on the client’s part.

The SAM (3) and COR (3) have no clinical significance.

Does the VAL score of 6 impact the results? Given the outcome was High Probability based on Rule 6, the impact is nil. The VAL is significant only if the outcome was Low Probability. However, with that score, the evaluator may hypothesize that perhaps the client was trying to skew the results but failed.

Questions remain regarding the current use of substances by the client. Is he minimizing his use or is he presenting an accurate picture? He was not defensive so perhaps his overriding concern was how he was viewed by the evaluator.

Treatment Considerations

Recommendations for the level of treatment need to be considered if he does have a diagnosable disorder based on the DSM-5. Actual current use also needs to be established. The elevated OAT score does indicate he will not feel out of place in a group setting. Prior history of substance use issues also need to be considered. It would appear, however, that outpatient treatment would be a consideration with the level of intervention to be determined by the overall assessment.

We recommend administrators of the SASSI have access to The Adolescent SASSI-A3 User Guide and Manual. It contains information on scoring, interpreting profiles and includes examples of profiles. It defines all the scales, what they represent, clinical considerations and giving feedback. The Manual also contains the research and validation information. Please call our Customer Service number for more information on how to order – 800-726-0526.

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Adult SASSI-4 Review: Does the SASSI evaluate for Video Gaming?

This is an interesting profile on a 23-year-old male as it brought up the question, we get on the helpline regarding video gaming. “Does the SASSI evaluate for video gaming addiction?”, especially if the administrator believes the client was possibly including video gaming as well as substance use in his answers. The simple answer is no, it does not, so please clarify with your client not to include video gaming.  A drug that is often associated with video gaming is Adderall so the follow-up question to a client who admits to excessive video gaming is to question what drugs are they using to maintain that level of energy and concentration.

This individual was instructed to complete the FVA/FVOD side of the questionnaire for the last 12 months.

RAP was 0.

High Probability of a Substance Use Disorder.

Prescription Drug Scale result was 3 so meets the cutoff for High Probability of Prescription Drug Abuse.

He met Rule 1 with a FVOD score of 21.

             Rule 2 with a SYM score of 7.

             Rule 4 with a SYM score of 5 (7) or more and a SAT score of 4 (7) or more.

Looking at the graph on the Profile sheet, you will see a significant elevation on the FVOD scale score – above the 98th% so he is openly acknowledging use of drugs. By analyzing his responses, you will gain insight into what circumstances he is using, including dealing with emotional or stressful issues. And remember, he is answering the FVOD questions based on the last 12 months.

The SYM elevation is above the 85th percentile – enough to meet Rule 2. Because SYM is a face valid scale, you can do content analysis on those questions to look at the symptoms and consequences of his substance use.

The OAT score is within the norm. It would probably be the case that he does not identify with other substance abusers. This may be related to his very low-DEF score.

The SAT score is within the norm but high. The administrator may pick up some denial or lack of insight on the part of the client. And again, it may be related to the DEF score.

The DEF score is very significant because it is so low, below the 15th percentile. This individual may be in emotional distress and may be suffering from depressive symptoms. He should be evaluated for depression as he may be using substances to self-medicate. He may also believe that if he wasn’t depressed, he would not be abusing substances thus the OAT and SAT scores may reflect this perception.

The Rx score is also very significant and warrants further investigation as to what prescription drugs he may be abusing and if, in fact, are related to video gaming.

The rest of the scores are within the norm, so not clinically significant.

In summary, these clinical results are hypotheses to explore with the client to determine the depth and scope of the client’s use in order to recommend a treatment plan which fits his particular needs.

We hope this is helpful to you.

The clinical helpline line is open for your inquiries, M-F, 12- 5 (EST) at 888-297-2774 and you will be directed to a clinical consultant. If we are not available, please leave a message and we will return your call.

And as always, Thank you for your interest in the SASSI.

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Adolescent A3 – Emphasis on COR Scale

This profile is a good example of needing to be careful with assumptions.

Overview of CORRECTIONAL (COR) SCALE

The COR scale provides information pertaining to the possibility that the client may have a relatively high risk of experiencing legal problems. It is composed of items that differentiated between people who had a history of involvement in the juvenile justice system and those who did not.

It is very important not to over-interpret elevated COR scores. Teens who have elevated COR scores are responding similarly to individuals who have violated the law. This does not mean that all clients with elevated COR scores have broken laws. Also, there is no empirical evidence that these clients are at risk for future offenses.

If a client has an elevated COR score, it is worth exploring those behaviors which may be leading the client to make poor choices, especially after using substances and magnifying the tendency to exhibit those behaviors. These include anger management issues, impulsivity, risk taking behaviors, low frustration tolerance or poor social skills. The task of the clinician is to help the client see the relationship of their behavior to the consequences they have experienced and introduce alternatives to regulate their emotions and behavior.

The SASSI A3 was administered on a 15-year-old male and the time frame for the FVA/FVOD was for the past 6 months. The caller explained this time frame was used as the client identified that his substance use became problematic during this time. He indicated he had initially started smoking marijuana but in the last 6 months started abusing Percocet.

There is a lot to look at in this profile below.

He meets Rules 1, 3, 4, 5, 6 and 8 so met the criteria of a High Probability of having a Substance Use Disorder. A reminder that more “yeses” does not necessarily mean a more severe problem or meets the DSM-5 criteria for severity.

His Rx scale score was 1.

The FVA (2) is below average and within the norm.

The FVOD (18) is highly elevated and close to the 98th percentile so he is very open about his use and under what circumstances he is using.

As seen on the profile graph, both the FRISK (2) and ATT (3) are within the norm though above average.  These scores indicate he is not necessarily using due to peer pressure nor does he have a strong belief or value system that endorses substance use.

The SYM (9) is off the chart. He is endorsing negative consequences and symptoms of his use as well as loss of control.

It is worth taking the time to look at how he has answered his face valid scales and do content analysis of his answers because these will generate a lot of information for clinical insight and discussion on how and why he is using substances. As a reminder, the face valid scales are the FVA, FVOD, FRISK, ATT, SYM and Rx scales. You cannot do content analysis on the subtle scales.

Both the OAT (8) and SAT (7) are above the 85th percentile. Although the OAT indicates he can acknowledge personal limitations, the higher SAT score indicates a level of denial or lack of awareness or detachment from feelings and may present himself functioning well.

The DEF (4) score is very significant as it is below the 15th percentile. This indicates severe emotional pain, and he may be exhibiting depressive symptoms so it is suggested a mental status exam should be conducted.

As usual, there is no individual clinical interpretation to SAM (4).

The last scale, COR (10) is highly elevated above the 98th percentile. He is identifying with those issues that are normally seen in juveniles with legal issues.

This is where one must be careful with assumptions because this client has had no legal issues for any reason. It is more productive to explore those issues he is identifying with and affecting his choice making.

It is also curious that one can be very open (based on the FVOD and SYM) yet have an elevated SAT score as well. This may be due to the DEF score and the emotional pain he is in. Hypothetically, he may believe that if he was not “depressed” he would not be abusing drugs.

Another aspect of the profile is to explore his Rx result. According to the client’s report, he is primarily abusing Percocet. His score may reflect he is getting it illicitly and not through a doctor.

Finally, regarding treatment considerations, the caller reported he has tried to quit using the Percocet for a week but relapsed. A treatment plan including inpatient should be considered considering his reported relapse.

We hope this is helpful to you.

The clinical helpline line is open for your inquiries, M-F, 12- 5 (EST) at 888-297-2774 and you will be directed to a clinical consultant. If we are not available, please leave a message and we will return your call.

And as always, Thank you for your interest in the SASSI.

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A SASSI-4 Profile Analysis: Prescription Drug Abuse

A caller requested help interpreting the result of a SASSI-4 questionnaire on a male client who presented himself as having an opioid addiction.

‘Curtis’ is a 36-year-old married man. He and his wife have no children. He works as a landscaper which he describes as physically very demanding. His parents smoked marijuana while he was growing up and Curtis also smokes marijuana. His older brother died ten years ago, and Curtis is still grieving. His brother also had substance use issues. Curtis also may have a history of being molested as a child which he does not remember, but his brother relayed that they were both molested by a babysitter.

Curtis reports a four-year history of opioid addiction which started as a result of a herniated disc in his back. He was initially prescribed hydrocodone for pain. He tried to quit once three years ago. Currently, he is ordering “stuff off the internet” or getting oxycontin from friends. He has been taking 180 mg/day with a maximum of 240 mg per day. It takes 150 mg. for him not to get “sick.” Curtis continues to smoke marijuana on the weekends about one time per week. He has a legal history of possession of marijuana in 2004 and attended an outpatient treatment program doing “what I had to do.”

He has been slowly tapering off the opioids for the past five weeks and currently is down to 80 mg/day.  His goal is to completely get off the opioids but he is not interested in residential treatment at this time because it is his busiest time of year. Although he has attended NA, he does not like it. Curtis is more drawn to Smart Recovery.

The SASSI-4 was administered for lifetime use on the face valid side of the questionnaire.

What were his SASSI-4 results?  Curtis has a ‘High Probability of having a Substance Use Disorder’ and a ‘High Probability of Prescription Drug Abuse.’

This looks like a straightforward profile on the face of it. His score of 42 on the FVOD and 18 on the SYM indicate someone who is very open concerning his drug use, and because these are face valid scales, content analysis could provide useful information to further explore with the client.

The OAT score of 6 is right at the 85th percentile. The client may be able to identify with some of the characteristics of substance users such as impatience, resentment, self-pity and impulsiveness. However, the SAT score of 8 is higher than the OAT and may blunt the ability for Curtis to have insight into his behavior. When the SAT is higher than the OAT, the client may exhibit a lack of awareness or simply denial around the impact drugs are having on his life. In this case and not unusual, opioid users do not see themselves as “typical” addicts. That may account for the OAT score.

The DEF score of 2 can be a ‘red-flag’ as it is below the 15th percentile. A score this low can indicate someone with poor ego strength, feeling helpless and hopeless and may be exhibiting symptoms that look like depression. The clinician may want to do a mental health screening or refer the client for screening.

The FAM score of 5 is also very low, below the 15th percentile. This can indicate the client is focused on himself and not that concerned about others. This does not indicate a personality disorder but given the client’s circumstances, makes sense that he would be more internally focused.

The COR score of 8 is elevated above the 85th percentile. He has answered in a similar way to people who have had legal issues for any reason. We suggest screening for those behaviors or characteristics we often see in that population. These can range from poor social skills, low frustration tolerance, risk-taking behaviors, anger management issues or impulse control issues. These issues could be impacting on Curtis’s choice-making abilities.

Finally, looking at the Prescription Drug Scale. With the score of 14, it is quite clear that he is identifying behaviors associated with prescription drug abuse. Again, as a face valid scale, looking at these individual items will generate a lot of information for the clinician. The clinician will need to look at treatment readiness, discuss medication needs, possible referral and other reported clinical issues.

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SASSI Identifies Rx Abuse (with video)

 ‘Reggie’ is a 37-year-old married man. He and his wife have two children. He works as a warehouse worker where he was recently injured in a shipping dock accident. He recently returned to work after being on worker’s comp for several months during which time he was prescribed opioids for his pain. He was sent to his employer’s EAP provider for evaluation after returning to work and struggling with coping with the continued pain and poor job performance.

Reggie T’s responses illustrate another profile often seen in people who acknowledge that they use drugs excessively and that it negatively impacts on their functioning and relationships.

Given Reggie’s high level of drug use and consequences, you might consider a more comprehensive evaluation to determine whether he may need supervised detoxification or other intensive intervention.

You may find Reggie ready to acknowledge that he uses drugs frequently and that he may also drink too much. However, he may not see that his behavior varies dramatically from others who don’t have a substance use disorder. Feedback on where his scores fall on the profile sheet may help him see that his behaviors are not typical. It may be useful to know that Reggie’s wife is currently in treatment for drug and alcohol abuse due to a DUI. Their mutual abuse of substances may help promote their beliefs that their substance use is normal. Examining the items that Reggie endorsed on the FVA, FVOD, SYM and Rx scales may provide useful insight into his motivations for using and help him see the consequences that result from his use.

In this first video watch Reggie’s initial EAP visit in which he was asked to take the SASSI.

This second video is the follow-up session where he discusses his SASSI results with the EAP provider.

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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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.

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