Tag: Low OAT

An Adolescent SASSI-A3 Profile: Low-Probability with Possible Clinical Issues

Alyssa (revised) is a 14-year-old female adolescent sent for evaluation by her teachers after noticing significant changes in her emotions and behavior. Her demeanor has gradually changed from a smiling, mostly compliant teen to that of a more rebellious and sullen one. She’s been caught skipping school a few times and was found to be in the company of some older adolescents who are consistently in trouble and suspected of using alcohol and drugs. The SASSI-A3 classified Alyssa with a LOW PROBABILITY of having a substance use disorder (SUD). Neither the VAL or DEF scale scores met the criteria for the possibility of a false negative. While the scale scores do not meet the criteria for classifying her as high probability of having an SUD, there are some other scale scores which could indicate some other clinical issues that may need to be addressed. 

In going beyond the decision rules and looking at the individual raw scale scores, it is possible to develop a more general hypothesis regarding her level of adjustment and functioning. The fact that she scored above a zero (0) on the FVA, FVOD and SYM scales tells us that, while her scores are not high enough to indicate the probability of an SUD and are in fact very close to the mean, at 14 years old she has used both alcohol and drugs and experienced some negative consequences and/or problems as a result of that use. Based on her elevated FRISK score of 3, her slightly elevated ATT score of 3 and her elevated COR score of 6 (along with the observations made by her teachers), we can further hypothesize that Alyssa is likely to be surrounded by a close social system who are abusing substances and, as a result of this, her attitudes toward substance use lean more toward endorsing and promoting such use as a good thing. Assuming that this social system likely consists of her peers, namely the older teens mentioned earlier, this may explain her elevated COR scale score. In other words, she may have similar thinking patterns, beliefs, values and attitudes as those who are more likely to engage in rule-breaking, unlawful behaviors and/or disdain for authority. Her OAT score seems to indicate that Alyssa does not at all identify with any of the typical attributes that we would normally associate with an active substance abuser and that she firmly believes that she does not have a substance use problem. One of the most concerning scale scores on this profile is the DEF score of 2. SASSI research tells us that very low DEF scores such as this, often indicate a young woman who is experiencing a great deal of emotional pain and many of the typical symptoms associated with a syndrome of clinical depression. She may tend to engage in negative self-statements, identifying herself as a loser or misfit. She may be experiencing a sense of hopelessness, inability to enjoy positive experiences, lethargy, general bad feelings, impaired functioning in vital areas such as sleeping and eating, and sometimes even suicidal ideation.

While a low DEF score is not a clinical diagnosis in itself, this profile raises some questions that a counselor may wish to pursue in an interview or further ongoing assessment. For example, what is causing the significant change in emotion and behavior that was noticed by the teachers? Is it simply the normal emotional volatility of a growing and changing adolescent? Is there something happening in this teenager’s family which has caused this sudden shift in emotion and acting out? In any case, hopelessness, suicidal ideation, depressive symptoms or other psychiatric problems are important concerns to be investigated. It would also be valuable to explore the extent and context of her drinking and drug use to determine if it is just normal adolescent experimentation, a reaction to peer pressure, or an attempt to deal with emotions too overwhelming to control on her own. While the SASSI does not indicate a high probability of having an SUD currently, without some sort of intervention regarding these sudden changes in emotions and behaviors, a future SUD problem is not out of the question. It is difficult to suggest appropriate interventions without further information. However, appears that she could benefit from seeing a safe, trustworthy and empathetic counselor who could further explore the issues and immediately address her emotional pain and help her develop coping skills other than alcohol and/or drugs. Using the raw scale score interpretations described previously, in an open two-way conversation the therapist and Alyssa could use these scores to begin to collaboratively develop a plan of action that could help her confront and overcome the difficulties she is facing.

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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SASSl-4 Profile Analysis – DOT Client

We frequently receive calls requesting clinical interpretation of profiles done on Department of Transportation (DOT) clients. These clients have failed their drug/alcohol screening and their license to drive has been suspended pending an evaluation. In this particular case, the client is a 68-year-old female whose alcohol level registered above the DOT threshold. Her SASSI result indicated a high probability of a substance use disorder based on Rule 9. As you see on the graph, most of the scale’s clinical results fall within the norm. DEF, at 11, is above the 98th percentile and FAM, at 12 is above the 85th percentile. The OAT score of 1 falls in the 15th percentile. The high-DEF score is not unusual in DOT evaluations. It is incumbent on the evaluator to determine what the defensiveness is about. The SAM scale is no help in this case because it is not elevated. An elevated DEF coupled with an elevated SAM indicates the defensiveness is related to substance use. The elevated FAM score indicates someone who is not comfortable looking at their own issues. And the low OAT score indicates someone who has difficulty acknowledging their personal limitations and shortcomings. The combination of these three scales provides information to the evaluator that most likely, this client is not going to be forthcoming in disclosing issues or problems. During the evaluation, another piece of information disclosed was the client’s admission of trying to manage or monitor her drinking to try to stay below DOT’s threshold of alcohol use. That certainly may be a red flag.

Since the SASSI is a screening inventory and does not diagnose, the evaluator needs to reference the DSM-5 to determine if, indeed, the client meets the criteria for a substance use disorder and if so, what level – mild, moderate, or severe. Based on that, the evaluator has a couple of options to consider. If possible, work individually or refer to an individual substance abuse counselor to establish rapport and work to get the defensiveness down. Motivational Interviewing is a good asset to pull out in this case. Another option is to refer her to an outpatient group setting with the goal of connecting her to other clients and also have access to individual counseling as well. Regardless, outpatient treatment seems to be the most likely intervention.

It would be helpful to acknowledge the financial impact on the client that suspension of driving privileges is having on her. That certainly could be triggering the extreme defensiveness we see in the results and the consequences for the client could be significant.

We hope these reviews are helpful and whether you are a new user or a very experienced one,

clinicians are here to help with any questions you might have. Clinicians are available M-F, 11-5 (EST). Call us at 800-726-0526 or 888-297-2774.

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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.

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