Tag: SASSI-4

A SASSI-4 Profile: When the Drug Use is Marijuana

It is no news that the use of marijuana is viewed by many, no matter what the demographic, as innocuous and far less than alcohol and certainly any other drugs. It has become increasingly difficult to convince users of the harm associated with marijuana use when the legal status ranges from fully illegal, to medicinal and/or decriminalized to fully legal. Users often describe marijuana as simply a plant so it is a natural and therefore a healthy alternative to alcohol and other drugs. This, along with the misconception that marijuana is not addictive, creates an inherent struggle for both the evaluator and evaluatee. As an aside, when writing this, I came across an article in the New York Times by Dana G. Smith (April 10, 2023), titled “How Do You Know If You Are Addicted to Weed?” The article itself gives good basic information but the most interesting part was the comments from readers which were all over the map.

Substance use evaluations for marijuana use become problematic when the client comes in with that strong point of view which may be reflected in the results of the SASSI and in the scales.

The question of diagnosis based on the DSM-5’s 11- symptom criteria and whether the client meets either mild, moderate or severe must be answered before any treatment considerations can be raised.

The following is a good example of what a profile looks like when the drug use in question is marijuana.

The client is a 19 year old female and the FVA/FVOD questions were answered for the last 12 months. The RAP and Prescription Drug Scale scores are 0.

CLINICAL INTERPRETATION

The client’s FVA is average but her FVOD of 13 is elevated above the 85th percentile so clinically significant. Her SYM score of 9 is above the 98th percentile so she is endorsing significant symptoms and consequences. It also indicates she is associating with either family or friends who are heavy users. This gives important information regarding her environment and the difficulty of a social system that supports recovery.

The OAT scale score of 5 is neither elevated nor extremely low. It would be plausible to say she does not identify with or see herself as a substance abuser. This is reinforced by both the SAT(6) and DEF(6) falling in the normative range. She is not in denial because she believes there is nothing wrong with smoking marijuana and so was non-defensive when completing the questionnaire. The only other clinically significant scale is COR with a score of 7, also above the 85th percentile. Whether or not she has legal problems, she has answered in a similar way to others with legal issues. Anyone looking at that result can evaluate impulsivity, anger management issues, low frustration tolerance, poor social skills or risk taking behaviors, all of which impacts choice-making abilities.

THE RULES

Out of the 10 rules evaluating for either a high or low probability of a substance use disorder, she meets 4 of them:

          Rule 2 (SYM=7+)

          Rule 5 (SYM=5 + and SAT=4+)

          Rule 6 (SYM=6+ and DEF OR SAM=7+)

          Rule 10 (FVA=14+ or FVOD =8+ and SAT=1+ and DEF= 4+ and SAM 4+)

To meet the criteria of a High Probability of a Substance Use disorder requires meeting only ONE rule. Meeting more than one rule does not necessarily mean a more severe disorder. The DSM-5 evaluates for severity ranging from mild, moderate to severe based on the number of diagnosable criteria met.

CLINICAL ISSUES TO CONSIDER

Giving clinical feedback to this client or any client for that matter, is to use the information they have given you from the questionnaire. Pulling information from this client’s questionnaire, the FVOD and the SYM responses can help start the conversation regarding how she is using drugs, under what circumstances and consequences of her use. For online users wanting access to the SYM questions, go to sassionline.com, log-in: go to ‘my clients’ tab; then ‘support materials’ tab. Under Adult SASSI-4 Online User’s Guide go to the SYM section, Pg.19. You will find a list of the SYM questions you can coordinate with your client’s completed questionnaire. A reminder: only with face valid scales i.e FVA, FVOD, SYM and Rx scales can you do content analysis of the questions.

The purpose of feedback is not trying to convince her that marijuana is a drug and she has a disorder but to use the information she, herself, has given you to explore how her drug use is impacting her in a negative way or in some ways interfering in her life.

TREATMENT CONSIDERATIONS

The OAT score result implies group treatment intervention would not be the first choice for this client. Information specifically regarding marijuana’s addictive qualities and impact on the body could be included in individual motivational counseling. Establishing a goal regarding her use, including reduction or abstinence is part of treatment planning no matter the context. Even though she is not defensive, establishing rapport and trust may be instrumental in facilitating this client to take a closer look at her drug use and eventually be open to group experiences.

If you have any clinical questions, be sure to call our free helpline to talk to our clinicians. We are available M-F, 12-5 EST at 800-726-0526.

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SASSI-4 Profile of Adult Male Involved in a Custody Suit with ex-Spouse

A substance use evaluation administered on an individual involved in a custody suit can reliably be fraught with issues. This one presents a number of them.

This 39-year-old client was instructed to complete the FVA/FVOD questions for his whole lifetime.

A significant issue was his history of 4 DUI’s from 2020 – 2021 while in the process of separation and divorce. He denies his current use is anything like it was during that period.

The SASSI result indicated a Low Probability of a substance use disorder.

His RAP was 1 but not enough to flag the results and his Prescription Drug Scale was zero.

Looking at how his scores compare on the graph; we first see the average scores of his FVA and FVOD scales which may be suspect given his DUI history. His average SYM score suggests he does not acknowledge significant symptoms or consequences of his use despite 4 DUI’s. Face Valid Scales are easy to manipulate or minimize if the client chooses as they directly relate to substance use.

Moving on to the subtle scales starting with OAT, we see it is very low but within the norm. If it were any lower, it would indicate he has a hard time acknowledging personal limitations and shortcomings so there may be a hint of that going on. It is the next two subtle scales which contribute the most. The SAT scale is below the 15th percentile and when it is this low can indicate the client is hypersensitive to what others think of him, maybe experiences feelings of rejection so comes across as having a chip on his shoulder.

The extremely high-DEF score (above the 98th percentile) questions the Low Probability Result.  As suggested, If the DEF is 8 or more, that increases the possibility of the SASSI missing individuals with a substance use disorder. It does not invalidate the result. There are many reasons for a high DEF – it could be situational – and it is not unusual in custody disputes to see a high DEF. It could be the client was defensive around their substance use. It could be that he has a defensive personality in general. The administrator is tasked with determining the meaning of the DEF scale score. It also tells you how to clinically approach a client who has difficulty opening up, is hypersensitive to others and is defensive.

The SAM score, though low, is the only scale which does not have an individual clinical interpretation. It is used in the decision rules to increase the validity and accuracy of the other scales it is paired with. It is also used to ascertain if the client is defensive around their substance use if both the DEF and SAM are elevated.

The FAM and COR results are not clinically significant.

In this kind of a case, the question of what timeframe to use with the FVA and FVOD scales comes up. It depends on several factors. Lifetime does give you an overall baseline of substance use but if you want a more “focused” timeframe, the last twelve months should be considered. Sometimes there is the issue of missing someone who had a significant issue in the past but is not currently using it, so a high probability result becomes a risk statement. A reminder:  the SASSI cannot determine what a client is currently doing. This inventory is part of the information gathered by the administrator which is incorporated into the whole assessment.

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The Interrelationship of Bullying, Shaming & SUD among LGBTQ Adolescents

As we approach the end of PRIDE month, we are pleased to share a short article we recently published that discusses substance misuse and explores the genesis and exacerbation of drug use among Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) teens. In the article, we look at the possible connection between bullying and other oppressive behavior (such as shaming) and acknowledged substance use and suicide. We hope you will take the time to read and share it. “Bullying and Oppressive Behaviors Towards LGBTQ Adolescents: Substance Use Disorders in the Making?”

We hope you will take the time to read and share it. “Bullying and Oppressive Behaviors Towards LGBTQ Adolescents: Substance Use Disorders in the Making?”

Opportunity for Experienced SASSI Users

If you enjoy sharing knowledge and have an enthusiasm for the SASSI, we invite you to consider becoming a certified SASSI trainer. We are looking for individuals to offer live in-person trainings to the public (open trainers) in their state/province of residence and possibly surrounding states/provinces, as well as individuals to provide training for their organization’s staff and their satellite offices (closed trainers).

Open trainers charge a fee to participants and advertise their training to the public (placement on SASSI website is provided). Closed trainers do not advertise to the public and do not collect a registration fee for providing the training. Both types of trainers can issue certificates of attendance with continuing education credits and all materials needed to provide training are sent at no cost.

Qualifications for trainers are as follows:

  • At least five years of experience in addictions or mental health counseling
  • Experience in assessment, group work, teaching, or workshop presentation
  • Experience using the SASSI, having screened at least 20 clients with it
  • Good verbal communication skills
  • Education: College degree or advanced degree or certification as a substance abuse professional
  • Experience in psychometrics helpful, but not required

Procedures for obtaining open trainer certification can be found here and closed trainer certification here. Please reply to scarlett@sassi.com with any questions or to apply.

How the SASSI can be a Useful Tool in the LGBTQIA+ Community

Overall, the SASSI can be a valuable tool for helping members of the LGBTQIA+ community by identifying and addressing substance use disorders. It can provide a standardized and sensitive way to screen for these issues and can help to ensure that individuals receive appropriate care and support based on their unique needs and experiences.

Read more

SASSI Online Tips and Tricks: Volume 5 | Account Dashboard Overview

SASSI Online is our web-based platform that supports the digital administration of the Adult SASSI-4, Adolescent SASSI-A3, and Spanish SASSI. It provides a report with interpretive paragraphs outlining the decision rules and results from client responses. In this edition of SASSI Online Tips and Tricks we review the Dashboard Tabs, their functions and what the different Roles have access to.

All SASSI Online users have a Dashboard. When logged in to their account, they will see the text in the top right corner, text that reads: “Account Dashboard for [name on account]”
Below is a description of each tab:

News – This space is used to provide updates from SASSI regarding research projects, questionnaire updates, and any other information specific to SASSI customers. Including these blog posts!

My Clients – This space is used to administer questionnaires, redeliver questionnaires, view reports, view completed questionnaires, and access the support materials page; this is where most of the work happens.

Admin Tab – This tab is only available to the Primary Clinical Contact (PCC). Here they can view client reports that counselors on their account have administered. The counselors cannot see the PCC’s clients, or those that belong to other counselors on their account.

Purchasing & Distribution – This tab is available to the Purchaser only. This space is used to purchase more questionnaires and manage distribution groups. Distribution groups are self-managing but can be customized to accommodate multiple counselors/users on an account who do not share a budget. The Purchaser can create Distribution Groups to add specific quantities of available SASSI questionnaires and add only the counselors/users that should have access to them.

My Account – This workspace will provide information about your account. If you are not the PCC and/or Purchaser, information about who is, is made available here. If you are the PCC, the list of registered counselors is found on this tab. All users can change their password and update account information and access their Customer ID. The PCC can also invite Counselors and Intake Staff to register.

If you are not currently using SASSI Online and would like to experience the features of the digital platform, create an account at www.sassionline.com. If you already have an account, let us know if you have any suggestions for our next edition of SASSI Online Tips and Tricks. As a bonus for reading this blog post to the end, reach out to us at blog@sassi.com, with the code phrase: Account Dashboard, to request two free SASSI Online administrations!

Elevated RAP/ High Probability Results on an Adult SASSl-4

This profile on a 21-year-old female with the FVA and FVOD, based on the last 12 months, is interesting primarily because it is so unusual.

As you look at the profile graph, all the scale scores are within the norm, i.e., between the 15th and 85th percentiles except for the SYM score which is above the 85th percentile. This tells you that she is acknowledging symptoms and consequences of her use and indicates she is associating with friends or family who are also heavy users. This is a bit of a contrast to her FVA and FVOD scores, both of which are above average but not above the 85th percentile.

The SAT score of 5 is within the norm which is a positive – no denial or lack of awareness or insight is indicated. However, with the OAT score within the norm, it is a possibility that she does not identify with other substance users and those characteristics we associate with substance users such as impatience, self-pity, resentment, or impulsivity. If marijuana is her primary drug, she may not see it as a problem so the high probability of a substance use disorder may be an unexpected result for the client.

Another positive is the DEF score, which is above average but not clinically significant since it is below the 85th percentile.

The client meets decision rules 5, 6 and 9 and 10 thus meeting the criteria for a high probability of a substance use disorder. As a reminder, more rules that are met does not mean a more severe problem. As we often mention on the clinical helpline, the diagnosis and severity of a substance use disorder is based on the criteria in the DSM-5.

Note the Prescription Drug Scale score of 2. It does not meet the cut-off criteria for prescription drug abuse, but it is worth a look at those items she endorsed.

The caller was puzzled by the RAP score of 2 and how it affected the result of the SASSI.

A RAP score of 2 or more always needs to be explored, preferably with the client. The two items which posed the problem were ‘I never have been picked on and I have never been sad’.
Cultural and language contexts need to be considered for possible reasons the client answered as she did. The possibility of her deliberately trying to ‘skew’ the questionnaire is low given the high probability result. More likely, the client answered accurately for her based on her life experience.

The clinician can now safely accept the overall result as valid.

As a reminder, the free clinical helpline, (800-726-0526) is available M-F, 12- 5 pm (EST) for any questions you may have. We also offer a free Q&A zoom meeting once a month for an hour as well. Please check the blog notice for dates and time to register. And finally, if you have additional inquiries, please contact the Clinical Director, Kristin Kimmell, LCSW, LCAC at kristin@sassi.com.

PDF Version Available for Download

Clinical Q&A and Live SASSI Training Webinar 

We are pleased that people have been joining us for our free one-hour online Clinical Q&A sessions hosted by our Clinical Director, Kristin Kimmell, LCSW, LCAC.  

We enjoy hearing how you are using the SASSI in your clinical practice and agencies as well as answering your questions and speaking to you all.  We have scheduled additional sessions that we hope you can join in on. You can reserve your spot and view available dates and times by clicking here. If you have profiles you would like to share with the group for discussion, please send them (de-identified) via email any time prior to the session to scarlett@sassi.com. Your contributions would be of great value. Also, a reminder that we have a live webinar on Administration & Scoring of the paper & pencil version of the SASSI on April 18th and Clinical Interpretation on April 25th. You can register by clicking here.   

Note that the Q&A sessions do not provide CEUs and are not a substitute for SASSI Training. SASSI training provides 3.5 NAADAC CEs per session. 

We hope to see you there! 

Research Update: New Publication in Women’s Health

The SASSI Institute recently published an article in Women’s Health on early intervention and resources for expectant mothers with substance use problems and service shortages in the present age. Within it, we discuss the need for more research and collaboration in regards to substance use disorder  and criminal Justice, especially to assist women avoid the stigmatization and ostracizing they may experience; many simply by virtue of having experienced the disease of addiction. When combined with the criminalization of drug use, society inevitably finds itself entrapping these women in a revolving door fed by the “drug-crime” connection, but now also including newborns. Babies should NOT be born in prison, especially sick babies; however, when they are, quality prenatal care, early intervention, and community support upon release from prison are imperative to help those babies and their mothers have positive long-term outcomes. Please consider this a call to action, we welcome your interest in collaborative efforts.

Pre-employment Screening / A Profile Review on the Proper Use of the SASSI-4

A recent caller wanted help in interpreting a profile completed by a 33-year-old male. He was instructed to complete the FVA/FVOD side of the questionnaire for the last 12 months. The administrator revealed during the call that the assessment was a pre-employment screening for the Department of Transportation. The helpline does receive regular calls from counselors who administer the SASSI-4 for the Department of Transportation after a driver has failed a drug or alcohol test for substances, but not for pre-employment screening.

In review, the client comes up with a high probability of a substance use disorder based on Rules 2,5,6 and 9. The RAP is 0 and the Rx Prescription Drug Scale is 0.

The FVA is below average use, the FVOD is on the 50th percentile. The SYM scale of 7 is above the 85th percentile, considered elevated and thus Rule 2 meets the criteria of a High Probability of a Substance Use Disorder. The rest of the scale scores are within the norm (between 15-85th percentiles) so clinically are not significant but are significant in meeting the criteria of a Substance Use Disorder if accounting for the additional rules of # 5, 6 and 9. The SAT of 5, being in the norm indicates the client was not in denial about his usage.

Considerations

Although the results do not account for current or actual use, further assessment may include urine screens that would give a more accurate representation of current use of substances. He does come up with a high probability of a Substance Use Disorder, so deeper inquiry is necessary.

The administration of this SASSI was part of a pre-employment screening and our position on the proper use of the SASSI in this regard, is very explicit:

From our User’s Guide and Manual: *

“The purpose of the SASSI is to help identify people who are likely to have substance use disorders so that early intervention and treatment can be initiated when appropriate.”

“To use the SASSI to discriminate against individuals violates the intent of the authors and may even violate the law.”

“SASSI results should not be used to abridge the rights of individuals or to disqualify applicants for positions, such as jobs or benefits, such as public assistance programs.”

Thus, it is extremely important to use the results in the most therapeutic way possible with the best intentions of helping individuals with a substance use disorder.

If you have any questions, please contact the Clinical Director, Kristin S. Kimmell, LCSW, LCAC at kristin@sassi.com.

*SASSI -4 User Guide & Manual – Chapter 1 (overview), pg.7
SASSI-4 Online User Guide – Proper Use of the SASSI. pg. 8