Tag: SASSI

Addiction Professional Spotlight: Charlie Stookey, MA, LADC, LADC-S

I have had the pleasure of being on staff at The SASSI Institute for 22 years. Throughout that time, I have had the opportunity to work closely with many addiction professionals. Their dedication and passion for helping individuals in recovery or in need of recovery have always astonished me.

One of these professionals whom I have known throughout my time at the Institute is Charlie Stookey, MA, LADC, LADC-S. Charlie was a trainer for the SASSI when I started my career at the Institute. He presented training on the earliest versions of the SASSI, having been taught by none other than our late Founder and SASSI creator, Dr. Glenn Miller. Charlie retired from training many years ago, and while we have never met in person, we have stayed in touch over the years, and I am glad to call him a friend. He attended Whitman College and the University of Nevada, Reno, and is currently a substance abuse counselor in Reno, Nevada. Charlie also has a passion for poetry and has been published in the West Coast Poetry Review, Blue Moon, and The Meadow. He believes in the gift of the Wounded Healer and Joseph Campbell’s The Hero’s Journey. I want to share one of his poems with all of you today and encourage you to take the time to read it peacefully.

Charlie asked me to share that he hopes the heroine in Phases of the Moon, finds the beginning of her sober journey in the reflection in the detox mirror. And that she finds the “life that awaits us.” In our groups, we are in a gathering of miracles and he is grateful for the opportunity to sit with them.

Phases of the Moon The new moon is a cat’s claw in the night sky. Clint C. Ricketts

Beneath Thunder Moons and Corn Moons, she names her four rescued cats, Moon Beam, Moon Light, Moon Shadow, and, of course, Moon Shine. The phases of the moon
are tattooed on the nape of her neck “to honor the mystery and permanence of the moon over time. It’s reliable.” It’s so easy to turn the course of her disease into the curse of the disease 
with its hungry ghosts. No glass Japanese floats lie atop the scarred nightstand; but earrings, ER receipts, doubts, matches, butt ends of relationships.
She regrets the drunken, meth-fueled fights with her husband, who later committed suicide. “Killed himself over…whatever. Me,
all that lottery money, heartache, whatever.” Moonlight creek sings to Cottonwoods in the darkness. Grief waxes and wanes.
When loneliness strikes, she writes lamentations: Full October moon Drowns pinpoint constellations. I miss your bright eyes.
The riptide from the fifth of a gallon a day floods the road of good intentions. Its ebb leaves tide pools of anxiety and depression ripening in a sour stomach. 
Each morning’s hangover brings the pounding of relentless reality, the ever-present eternal goddam now. Last night’s shame haloes her head in hangover vises. She pukes. Starts the hands-and-knees
search party for dimes or quarters or pennies for a half-pint of mercy. She ignores the snores of an anonymous cowboy under a throw and the spray of clothes.
She wipes withdrawal’s sweat from her face, swipes at the brain fog. The riptide created by her moons leaves an empty curse. She flings the empty purse
of promises into the furthest corners of cobweb resolve, another tourist attraction. When the new moon slides between sun and earth, the eclipse covers her soul like a shawl.
She peers into the silvered glass of the detox bathroom mirror, where a stranger greets her. A shadow of comfort arises when she strokes her new moon, colored and frozen on her neck

Interpreting the Spanish SASSI

Carlos C. is a 36-year-old Mexican-American male who’s Spanish SASSI results indicate that he has a high probability of having a substance use disorder based on “yes” answers to Rules 1, 2, 3, 4 and 6 and because his FPOS score is 5 or less (FPOS=2). Validation studies indicate that 86% of the people who have substance use disorders are correctly classified by the Spanish SASSI based on the Decision Rule (High Probability) and the False Positive Check (5 or less).

In addition, Carlos has an SCS score of 8 or more (SCS=9) indicating that he is more likely to have a substance dependence disorder than substance abuse. In validation studies, the majority of people (77%) who are test positive on the Spanish SASSI and have SCS scores of 8 or more have a substance dependence disorder rather than substance abuse or no disorder.

The Administration and Scoring Instructions and Development and Validation of the Spanish SASSI provide detailed information on interpreting the Decision Rule results, the False Positive and False Negative Check (FPOS and FNEG) and the Supplementary Classification Scale (SCS).

Three of the Spanish SASSI scales, FVA, FVOD and SYM, are composed of “face valid” items that address substance misuse in an apparent or obvious manner. Some questions address inability to control usage. For example, on one of the FVA items, Carlos acknowledged that on several occasions he has had more to drink than he intended to. Other items on these scales reflect usage in order to better cope with negative feelings or other problems. Carlos, for example, reported on one of the SYM items that when he is anxious, he feels the need to drink. The face valid scales also include items that address negative consequences of substance misuse, such as physical, emotional and relationship problems. Carlos indicated on an FVA item that on several occasions his drinking has led to problems with friends and family members, and on a SYM item he acknowledged that he has had a drink first thing in the morning to steady his nerves or get rid of a hangover.

As you can see, by reading clients’ answers to specific questions on the FVA, FVOD, and SYM scales, it is possible to gain greater understanding of the types of problems they may be having with alcohol and other drug usage. Also, providing feedback to clients on the types of problems they have identified on the face valid items of the Spanish SASSI may be useful in the process of establishing treatment goals.

The remaining scales, OAT, SAT, DEF and SAM are subtle scales — i.e., the items that comprise these scales do not address substance misuse in an obvious or apparent manner. Therefore, Carlos’ responses to questions on those scales cannot be readily interpreted. The SASSI Institute provides guidelines for interpreting four similar scales as they appear on the English versions of the SASSI. However, the subtle scales on the Spanish SASSI are not identical to the English scales, and there is not enough information available to formulate guidelines for interpreting them for clinical purposes. The SASSI Institute, therefore, does not recommend interpreting scores on the subtle scales for clinical purposes. We will however, be delighted to help you with scoring or administering the questionnaire.

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A Message to Our Colleagues, Customers and Friends

We would like to take this opportunity to invite you, our many colleagues, to express your views, research findings and other developments within our SASSI Network blog. Our intent with this forum has always been to embrace the opinions and experiences of so many professionals and treatment providers throughout the country and indeed throughout the world. This forum is meant to be one of inclusion, not exclusion. All professionals from the multitude of addiction services provided have value and merit inclusion. These might focus on screening, testing, assessment, treatment, interventions, and others. We invite your submissions, and welcome your viewpoints. We feel this forum provides an opportunity to enrich us all with a collective wealth of knowledge that will ultimately enrich the addiction field. If you would like to contribute, please contact us at blog@sassi.com.

We hope that all of you and your families have managed to stay healthy during this tumultuous year. Our hearts go out to those that have experienced loss, suffering or pain during this Pandemic that has taken far so many lives. We remain hopeful that now that several vaccines are in distribution, and vaccinations are proceeding expeditiously, that we are nearing the close of this chapter in all our lives.

Please consider joining us by contributing your knowledge to our blog!

Interpreting the Results of an Adolescent SASSI-A3 with a High OAT Score

Happy New Year everyone!

I received my first Adolescent A-3 call on the helpline and was so excited and when I heard the numbers, I knew exactly why the clinician was calling.

As you look at the profile, you can see most of the numbers are within the norm. He meets Rule 6 so comes up with a High Probability of a Substance Use Disorder and no Prescription Drug Abuse.  So, what clinical information can the scale scores give you with so few scales outside the norm?

Although the FVOD is within the norm, it is above average and as recommended, you can do content analysis of his Face Valid scales. Another scale to pay attention to is the OAT score of 7 which is elevated. This suggests the client can acknowledge personal limitations and shortcomings and identify with other substance abusers. However, he may not want to or think he can change. The other significant score is SAT with a score of 1 which is below the 15th percentile. This suggests he may be hypersensitive to others and comes across as having a chip on his shoulder. This gives you good information on how to approach this client, especially when giving him feedback as you process the results with him because he is not giving you a whole lot of direct information regarding his use.

A word about the VAL of 6. If the numbers had resulted in a Low Probability of a Substance Use Disorder, you would question the results and do further investigation. Because he met Rule 6, there is no need to address the VAL. That said, with the VAL being so high, was this individual trying to manipulate the questionnaire and didn’t succeed?

Finally, users of the older version will notice that the SCS has been eliminated. This will require your use of the DSM-5 to determine the diagnosis and level of severity from your assessment.

Hope this information is instructive and assists you in your practice. And remember, as usual, we are here to help, so give the clinical line a call at 800-726-0526, press 2.

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New Publication!

The SASSI Institute is pleased to announce the publication of its newest manuscript “Mental Health and Substance Use Disorder Co-Morbidities Among Teens in Treatment: SASSI-A3 Correlations in Screening Scores.” Within this article, we review data from teenagers in treatment focusing on mental health diagnoses alongside a DSM-5 diagnosis of substance use disorder. Our hope is that by identifying possible correlations between SASSI-A3 scale scores and diagnosed mental health disorders, (depression and anxiety in particular), will provide clinicians with additional tools to direct the course of subsequent clinical interviews, in particular for teens suffering from co-occurring disorders. This Open-Access article is available here: Mental Health and Substance Use Disorder Co-Morbidities Among Teens in Treatment: SASSI-A3 Correlations in Screening Scores

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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As 2020 Comes to a Close: A Message from the CEO

This year has been unusual in so many respects. Our resolves, faiths, and tenacities have been tested for over ten months now. We have suffered losses and multiple pains, including emotional, mental and physical. We have endured an almost constant barraging drain on our senses. For over two straight weeks now we have experienced more than 100K daily COVID-19 cases nationally. As a result, many of us have lost loved ones, friends, or colleagues. Many more have been unable to see our loved ones, but for the benefits of social media.

I for one, have been unable to see, hold, and hug my family for close to a year. I consider the risks too high to endanger myself and those I love any more than I have to. But I also know I am not alone and I know we are looking forward to a really great Holiday season next year; we will celebrate twice as hard in 2021. Various vaccines and antibody drugs are in development, and we should all be immensely grateful to all of the scientists, nurses, doctors, caregivers, and caretakers, that risk their lives daily in the hopes of developing something fast, and caring for the ill until we do.

Yet the truly amazing thing, what is truly astonishing is that despite these pains, throughout these arduous journeys, throughout these uncertainties, we have found the inner strength and fortitude to trudge on. A true testament to the human spirit. Through it all, we have managed to be there for one another, for our friends, colleagues, and for our families. We have remained united, and that should be foremost in all our minds.

In my humble opinion, in order to succeed and defeat this Pandemic in the end, it is in our best interests, indeed our civic duty to maintain our focus on what needs getting done. Let’s each do our part by adhering to the CDC’s policies and protocols. It also our fervent hope that at some point soon, the entire country is protected with enough COVID vaccinations that we successfully eradicate this Pandemic as we have historically done to other calamitous diseases in the past.

In the meantime, our staff, Board of Directors, and myself, offer you only the best for the coming year. Better times lie ahead!

Be kind to yourselves and let’s make it our mission to take care of each other, as best we can.

Happy Holidays!

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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Coronavirus Vaccine Hopes

Dear Friends,

On Monday, November 9th,the CEO of Pfizer announced positive early results from its coronavirus vaccine trial, citing an over 90% effectiveness rate during its first phase of clinical trials. This is truly monumental news of worldwide significance. This fact has renewed hope throughout the country, indeed throughout the world, that we were finally coming closer to achieving a response to this deadly Pandemic. We at The SASSI Institute maintain our fervent hopes that in light of the over 100,000 daily national cases that have now become the norm, as a country and internationally, we will soon be able to eradicate this unfathomably terrible disease.

Given the recent spikes, like so many other businesses throughout the country, we recently had to again minimize our in-office time for all staff, including our shipping department. Nevertheless, all of our departments are open for business, and we want to reassure you that we will ship your products out on time, and as promised. We also want to remind you that we maintain our schedule of a December 1st SASSI Adolescent-3 release and that we have several articles in submission while we await their scientific review. Please contact our Customer Service team for pre-ordering information, and/or our Training Department for our upcoming training schedules.

I am delighted to announce that our Board of Directors and management team want to assure you that given this calamitous year, and in the hopes of giving our customer base a hand-up, we will not be raising prices in 2021. In fact, if you are experiencing financial difficulties, please contact our Customer Service Team and/or our Training team. They are more than willing to make suitable payment arrangements and offer their assistance during these difficult times.

We sincerely hope that you, your families, and colleagues remain safe. We remain confident that better times lie ahead!

Stay safe!

Warmly,

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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