It is with great pride that we announce the release of our latest adolescent research manuscript. This article is based on one key aspect of the Substance Abuse Subtle Screening Inventory (SASSI) Institute’s forthcoming third iteration of the Adolescent Substance Abuse Subtle Screening Inventory (SASSI-A3). While our primary goal was to develop a screening tool for adolescents that is concordant with the diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5) guidelines, we found other aspects of the instrument that we felt were beneficial to investigate further. This article, Vaping and Edibles: Self-Reported Usage Patterns Among Teens In and Out of Treatment, focuses on questions regarding cannabidiol (CBD) edible consumption and the extent of vaping to review and subsequently address these dangers in teens.
Teens that begin using alcohol, drugs, and tobacco early in adolescence are more likely to engage in vaping and edible usage. They are also more likely to use at a more frequent rate. Early intervention is a critical component towards preventing possible negative outcomes for substance misusing teens. Identifying these patterns will inevitably direct the course of subsequent clinical interviews and treatment planning.
Our Team at the Institute has been working tirelessly on a two-year research project to bring you an updated adolescent instrument that is validated against the DSM-5 diagnostic criteria. Our research has produced multiple publications and allowed the SASSI-A3 to include some new features, including a brief scale, Prescription Drug (Rx), to accurately identify teens likely to be abusing prescription medications. The updated version also includes new subtle items to reflect current teen alcohol and drug use patterns, as well as several updated questions using contemporary teen verbiage, and additional Face Valid items to identify symptoms in the DSM-5. The instrument also distinguishes likely Substance Use Disorder (SUD) from other psychological disorders; thus, the SASSI-A3 can accurately identify the presence and the absence of SUD, even when other psychological symptoms are present.
The SASSI-A3 will be available through SASSI Online immediately upon release and SASSI Online users can begin using it immediately on December 1st. Paper & Pencil product will be available for pre-order starting November 1st, with our first shipment of SASSI-A3 product/s scheduled for December 4th. After December 1st, the Adolescent SASSI-A2 Paper & Pencil material will remain available for purchase for a limited time, or while supplies last.
This has been an interesting year hasn’t it? I’ve worked in the behavioral health field, primarily substance use disorder, since 1989. During those 31 years I’ve never come across the types of challenges I’ve seen this year, for those struggling with substance addiction and for those healthcare providers trying to help them.
“Social isolation” is the new mantra in the culture and yet it is the very thing that is anathema to behavioral health counselors trying to help individuals coping with addiction. Resources are going out of business and events which once brought enjoyment, support, solidarity and an alternative to substances for having fun are being cancelled one after another. Fear is paramount, and it’s drastically shaping the face of addiction and recovery. We are seeing more initiation of substance abuse, more cycles of relapse and overdose, and more barriers to successful recovery in order to cope with a world in chaos. While outpatient treatment programs have successfully used technology to transition to online counseling groups, this has presented a barrier for those without the resources to purchase the technology needed to participate. For the last 10 years, I’ve worked for a local non-profit treatment center for women and adolescent girls here in Dallas, Texas called Nexus Recovery Center. Recently, the Executive Director, Heather Ormand, wrote the following in a blog post:
“COVID-19 has stripped so many sober women of our community. Twelve-step meetings are no longer being held in churches. Churches are closed or access is limited and people are afraid to sit shoulder to shoulder right now. For those with long-term sobriety and a strong support system, we can probably get by with Zoom twelve-step meetings, reading literature and connecting with other sober women via text or calls. But what about the woman struggling in her disease? The woman isolated in an unsafe home without the resources to leave and get treatment? The woman without a place for her children to go while she tries to piece together continuous days of sobriety and start rebuilding their lives?”
But there is hope. Treatment staff have proven that they are indeed essential, and programs like those at Nexus Recovery Center are showing that recovery staff are willing to risk getting sick themselves in order to help another human being break the cycle of addiction. They are showing that empathy and compassion and hope can still be conveyed through a mask or through a live, online group or individual counseling session. We can still find innovative ways to connect and share our experience, strength and hope with those who are struggling to find someone who cares.
I’ve also been associated with The SASSI Institute as a trainer for the past 25+ years and have found them to be an organization that strives hard to give agencies effective and easy to use resources for helping identify individuals struggling with a substance use disorder and guiding them to the most appropriate path for their recovery journey. I’m also proud to have been allowed to help people on The SASSI Institute’s Clinical Helpline for the past few years. One consistent thing I hear from callers is how much they appreciate the fact that they can reach out in frustration or puzzlement over a client they are working with, and how those on the Clinical Helpline are always there to help them work through a SASSI screening result, craft how to phrase the results to the client or in a report, and guide them in helping clients discover things about themselves, in order to initiate their recovery process. The SASSI Institute, though at a “social distance,” is there for me like a warm blanket on a cold night and for many other behavioral health workers in the US and in other countries who sometimes just need a willing ear to process some of their cases and SASSI results. Working together we can get through 2020 and beyond, despite any obstacles.
We wanted to provide you some important SASSI updates. We’re excited to announce that the research findings on the adolescent SASSI-A3 have been published! Within the coming weeks and next few months, we will be concentrating our efforts on publishing the SASSI-A3 instrument, which similarly to the adult screening tool, now includes a prescription drug scale and greater sensitivity to opioids and prescription medications. The updated instrument will be available on our online platform immediately on the release date. We will provide additional details and pre-ordering information as soon as we have a confirmed availability date. You can read the published finding here: Validity of the Adolescent Substance Abuse Screening Inventory-3 (SASSI-A3). We also expect to publish other manuscripts examining co-occurring disorders among some of these adolescents; and the increase and dangers of Vaping as a drug source for them and adults, which has increased dramatically in recent years. These manuscripts are in submission and we hope to have them published by year end as well.
On another note, despite wonderful advances in securing possible cures and vaccines, COVID-19 clinical trials, and worldwide collaboratives to address this virus, the unfortunate reality is that the case numbers continue to climb and sadly, the death toll continues to rise. This has forced many states and local governments, and even the federal government, to change well thought initiatives and plans, and even back-track on some of the openings and relaxing of public health statutes. As a result, many private practitioners and even some long-standing programs have had to continue furloughing operations, or sadly cease operating altogether. With even greater sadness, we have heard multiple reports from the substance abuse, treatment, and correctional field/s about the loss of family, colleagues and friends to this devastating disease, and our hearts and prayers continue to go out to their families.
The SASSI Institute remains committed to helping you stay connected and feel supported during this period of uncertainty. We will be informing you of developments as they occur on our end. But for now, please accept heartfelt wishes from all of us, that you and your families remain safe.
One of the trickier aspects of incorporating the SASSI results in a substance use assessment is extracting the clinical interpretation of what elevated scores mean and the relationship between the scales. If you have taken SASSI training, especially the Clinical Interpretation session, you were introduced to ‘Profile Configurations.’ This section gets more in-depth into interpreting the scales and clinically drawing on information that can better inform how to work with your client as well as consideration of treatment modalities.
Starting with the Face Valid Alcohol and Other Drug Scales versus Subtle Scales, which when one of those is elevated can make a big difference on how you approach your client with the results. A high probability result based on only Face Valid scales can indicate good treatment readiness, life-style issues (that is, how they are functioning at work, school, home, etc. and been acknowledged by the client), with behavioral consequences being greater than psychological addiction. The client can readily tell you how their life has become unmanageable. With this client, group therapy and/or support groups could be considered.
A high probability result based only on Subtle Scales is going to feel more like a brick wall. The client exhibits less awareness and may not be able to, or doesn’t want to acknowledge a problem. This could be based on having experienced only a few negative consequences so they do not feel the impact of their addiction. They could also come across as defensive. Finally, they could be ‘sincerely deluded’ and at this point, unable to connect the dots for themselves. This client will need a lot of support to become aware that their use of substances is having an impact on their life functioning. Individual therapy may be the initial therapeutic intervention working towards other modalities as needed.
If you have attended Session II of SASSI Training, you received an outline of scale interpretation. But we would like to make sure all SASSI users have access to this valuable resource. You can download a copy by clicking the following link: “SASSI Scales in Interpretation & Feedback.”
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 888-297-2774 or 800-726-0526, press 2.
The Substance Abuse Subtle Screening Inventory (SASSI) has been used successfully in correctional screening in multiple settings since its release. These include outpatient evaluations of offenders as well as assessments of incarcerated individuals in federal, state, and local correctional centers.
Many clients served in behavioral health and substance abuse treatment programs have histories of involvement with the criminal justice system in addition to mental health and substance use disorders. Samples in the SASSI-4 validation study included assessments in community corrections, probation and parole and drug courts, as well as cases from DWI and DOT education and screening programs. SASSI-4 overall screening accuracy in criminal justice settings was 95%; in DWI and DOT education programs SUD screening accuracy was 91%, and these accuracy levels were found not to differ significantly from the overall accuracy rate for all settings (92%). In addition, many cases included routine information on clients’ number and types of arrests and blood alcohol levels. Analyses revealed that SASSI-4 screening accuracy was 92% for clients with a history of criminal offenses, and 90% for clients who had no such histories.[i]
Interestingly, of those who had been diagnosed with a substance use disorder, criminal offenders acknowledged significantly less illicit drug use and consequences as well as less alcohol use and consequences on the SASSI-4 face valid scales than did clients with diagnosed substance use disorders in settings other than criminal justice programs — suggesting offenders minimized reported use and substance-related problems. By contrast, offenders with substance use disorders showed no differences in their endorsements of subtle items on the SASSI-4 compared to individuals with substance use disorders in other types of assessment settings. Despite offenders’ attempts at minimization, SASSI-4 overall accuracy in the offender samples was 94%. Together these findings illustrate strengths of using SASSI-4 to screen criminal offenders as compared to entirely face valid screens such as the AUDIT, CAGE or DAST. That is, the inclusion of subtle items on the SASSI-4 as well as a scale to identify clients’ level of defensive responding strengthens the ability of the SASSI-4 to accurately identify clients with substance use disorders.
In addition to legal offenses and possible substance use disorders, offenders also often have other mental health problems, which can affect their responses on many types of assessments they are given. Research on the SASSI-4 has shown its screening sensitivity is 98% in dual diagnosis clients; specificity is 93% in persons diagnosed with nonsubstance-related psychological disorders only, for an overall accuracy rate of 97% in people suffering from other psychological disorders. Moreover, accuracy was shown to be unaffected by ethnic background, and other demographic variables such as age and education.
For information on integrating the SASSI-4 into correctional programs, contact us at 800.726.0526.
[i] For additional validation information please refer to: Lazowski, L.E. (2016). Estimates of the reliability and criterion validity of the Adult SASSI-4. Springville, IN: The SASSI Institute.
Through the years, we have had the opportunity to share inspirational stories with our colleagues about their experience using the SASSI. One such story came recently from a psychologist who uses the SASSI in his practice. This was a gratifying story for us to hear and we are pleased that he has allowed us to share it with you.
The mother of a 22-year-old woman called me because she felt very strongly that her daughter Aimee (not client’s actual name) had an alcohol problem. But Aimee was adamant, no question about it, “I don’t have a problem.”
After some persuasion, Aimee agreed to come into my office, and I invited her mother to stay in the office during the interview, with Aimee’s permission. I really think Aimee was very certain that there wasn’t a problem, and that having Mom there during the process would convince her mother of this, too. I said, “You know, Mom can be a bit of a reality check here, but I’m listening to what YOU are saying.” Aimee’s mother agreed to just listen, since she had had her say when making the referral.
We talked about it, and Aimee restated that she didn’t have a problem. She was just not aware of any bad consequences coming from drinking. Aimee really seemed to believe what she was saying, “My friends and I, we don’t have any consequences; we just enjoy drinking.” I told her that was fine and asked, “Would you like to find out if you, in fact, do have a problem, or would you rather not know?” Of course, this is right in front of Mom. And she thought about it, seeing herself as being free to say “no.” But she did say, “Yeah, I think I would want to know.” When asked about each of the DSM diagnostic criteria for substance use disorders, Aimee answered no to all symptom questions.
Then, I brought out the SASSI-4, and told her a little bit about how it would compare her responses to two known groups of people: those who have a problem and know it, own it, and the other group that is just as aware that they do not have a problem, and own that. And we will see how your responses go. She agreed that that sounded good. She took the SASSI-4, and her responses showed a high probability of having a substance use disorder. This was very surprising to her. Then I went back and showed Aimee her scores on the FVA and the SYM.
When she looked at those scores, she could see by the profile that the consequences she was getting were way out of line compared to ordinary people who drink. She runs with folks whose norm is to drink a lot, and there is a history in her family of substance use issues. She just said, “It’s almost like thinking about it and realizing that you are surrounded, and your best bet is to give up!” She surrendered to the idea that, “Yes, I’ve got a problem.” From there on she was willing to do something about it. Aimee made an appointment to see me again, and we went on from there.
Let’s say that the SASSI did not exist, and I would have had only the DSM criteria and her history. I would have had her mother’s reflections and thoughts and observations, and—I don’t feel certain, but I’m guessing—she would have walked away with the understanding that she did not have a problem. She would have gone on as she had been—because I would not have been able to make a case that she did have a problem, because there would have been no data to base that on. She may well have been one of those who left the interview, and for the rest of her life said, “No, I don’t have a problem, so get off my back.” In a sense, I really believe that the SASSI saved this young woman’s life, or at least spared her significant pain. I have always been impressed by the accuracy of the SASSI. It picks up on people who really are “sincerely deluded.” It’s interesting that her score on the Defensiveness (DEF) scale was not particularly elevated, so it was not that she was being defensive, she was just unaware of how her drinking and symptoms associated with it were beyond the norm. Her elevated SAT score – at the 98th percentile – supports the interpretation that Aimee has little insight into what may be motivating her to drink with her friends, or the negative consequences that follow from spending time that way. I am very grateful for the SASSI, and I wouldn’t do an assessment or a screening without it. I literally would refuse, because just the verbal reports can be so misleading, although not intentionally misleading, necessarily. Clients will compare themselves with the people they know who are much further along in the addiction process, and not really understand that their own behavior is a problem, just because their own behavior is not yet as severe as what they see in others. The SASSI can put a client’s use into a broader, and often more realistic context.
Original depiction, written by Nancy Winningham, M.A. based on an actual experience a clinician had using the SASSI with a client. Adapted to reflect SASSI-4 information.
In a previous post, we discussed how the COVID-19 crisis is affecting the substance use disorder field throughout the country. Unfortunately, last week showed a dramatic increase in the number of reported cases nationally, particularly towards the end of the week (more than 40,000 additional reported cases, mostly from the west coast and southwest). As a result, many colleagues that had reopened for business to provide clients with critically needed services, unfortunately, had to close their doors again. Locally, we also experienced spikes. Not unexpectedly, we have seen a larger number of conference and venue cancellations than the already high numbers of cancellations reported previously. Fortunately, several venues have opted to hold teleconferences, thus allowing for a return to some semblance of normalcy.
Our number one concern at The SASSI Institute is maintaining the safety and care of those in the greatest need of help, the clients under your care. To do so effectively and efficiently, counselors, therapists, doctors, nurses, and all of us collectively, that engage in the work we do, must prioritize taking care of ourselves and practice the necessary precautions to enable those protections. We must adhere to the recommended CDC guidelines, including practicing social distancing, and engaging in frequent hand-washing.
We want to report that internally, as a result of some local area infection spikes, regretfully we had to postpone the dates when we expected full operational in-house staffing. Despite this needed precaution, we have maintained our shipping capacity of paper products and our SASSI-Online platform is fully operational. All other departments remain available during normal work hours to answer questions and provide assistance.
We are also very happy to report that our research department has three articles submitted for publication. And perhaps most importantly, we continue to ardently work on the upcoming release of the third iteration of our adolescent screening tool (SASSI A3). As previously reported, our adolescent “Fake Good” article was published in Alcoholism Treatment Quarterly in late December 2019.
The SASSI Institute remains committed to helping you stay connected and supported during the COVID-19 crisis and these other periods of strife. As always, please accept our heartfelt wishes that you and your families remain safe.
We at The SASSI Institute wanted to update you on the COVID-19 crisis and how we see it affecting the substance use disorder field, not only here in southern Indiana, but also as reported from our many contacts throughout the country. The unfortunate reality is that many private practitioners, and even some long-standing programs, have had to furlough operations or sadly, cease operating altogether. We have lost many colleagues and personal friends to this devastating disease from the substance abuse, treatment, and correctional field/s, and our hearts and prayers go out to their families. Another grim reality is that those in greatest need of our help, our patients, are most at risk during these precarious times of calamity. Sadly, many of our gathering spots, conventions, and venues have been cancelled or postponed, in some cases, for several months. These venues allow us to dialogue, and although we may not always agree, the sharing of information and ideas is what ultimately makes us stronger.
Internally, within the coming weeks, we will increase our shipping capacity for paper products to three days a week, depending on demand. And as I said in an earlier post, we are all looking forward to getting back to full operational capacity soon, but first and foremost, our greatest concern is the safety and well-being of our staff and customer base. During normal work hours, we remain available to answer questions, assist with order placement, and provide clinical support. Our SASSI-Online platform is fully operational, and staff remain available to offer assistance, technical support, and guidance as needed.
I would be remiss if I didn’t call attention to the racial, political, and criminal justice divisions that are currently affecting our country in so many devastating ways. Black lives DO matter, as do the lives of us all. These and so many other serious issues are affecting our country presently. It is no longer acceptable for us to simply state words; indeed it is now a time more than ever for us to unite and not divide. Regardless of race, creed, color, religion, sexual orientation, or political persuasion, we must focus our energies on that which will make us all collectively stronger. We must infuse a greater awareness of injustice in its many forms and manifestations, address these whenever possible, and enhance the dialogue leading to collective, constructive action. For us to become a greater part of the solution in creating a more just society, we must first understand that all of us can and must play a role.
The SASSI Institute remains committed to helping you stay connected and feel supported during the COVID-19 crisis and these other periods of strife. We will be informing you of developments as they occur on our end. But for now, please accept heartfelt wishes from all of us, that you and your families remain safe. #alonetogether
