Tag: SASSI

The “Unaware” Client

The client, Carol, is a 43-year-old married female, a successful business woman and mother of two children. She recently was arrested and charged with her first DWI after leaving a business dinner with sales associates. This is the first significant consequence related to her drinking. She claims that she does not have a drinking problem; however, she characterizes her mother as an alcoholic.

As we take a look at her scores, first notice that Carol appears to have responded in a meaningful way to the items on the SASSI-4 (RAP=0). However, there is some evidence that she may have approached the assessment process in a defensive manner (DEF=8). Despite her apparent defensiveness, the SASSI results indicate that she has a high probability of having a moderate to severe substance use disorder (SAT=7 leading to a positive on decision rule 4).

Given the elevations on the SAT and DEF, we get the sense that Carol may have some difficulty recognizing (high SAT) and acknowledging (high DEF) the nature of her substance-related problems. Yes, it is true that she reports significant problematic use of alcohol (FVA=10). However, it will be important to review with her the content of her responses on the face valid alcohol scale in order to gain some understanding of how she views these consequences. Our experience with the SASSI and our knowledge of the nature of the addictive process suggest to us that individuals who have elevated SAT and DEF scores (especially when OAT is average or below, as is the case here) often have difficulty seeing the manner in which their drinking has pervaded other areas of functioning. Therefore, it is reasonable to expect that much of what she has reported on the FVA may be flavored with a theme of, “I’m so embarrassed about these things, but thank God I don’t have a problem.”

Carol’s FAM score is elevated (13), suggesting that her responses are similar to individuals who have a history of being in relationships with others who are substance dependent. This is often related to a tendency to focus on others and a need to try to control the external environment. Elevated scores on SAT, DEF, and FAM suggest that Carol is likely to have an exceptionally strong tendency to deflect attention away from any suggestion that it is important for her to make significant changes in her life. Carol’s lack of awareness and insight may not only be rooted in her own addictive disorder but may also be fostered by a long history of trying to cover up for her mother and feeling responsible for the family’s welfare.

Despite Carol’s inability to see her substance misuse as a serious problem in her life, the SASSI results clearly indicate that she is likely to meet the diagnostic criteria of a substance use disorder. Therefore, effective treatment planning will need to include some form of addictions therapy, most likely at the outpatient level of care. The therapeutic challenge for the treatment provider will be to establish a working relationship with Carol that is conducive to helping her explore the substance abuse issues in her life. This usually means starting where the client is and moving her in a direction of increased awareness and insight regarding the nature of her own substance use problems and the changes that can help her begin a process of healing and recovery.

Carol comes to the treatment setting with recognition of her mother’s alcoholism. She has a desire to disclose information about her life growing up with an alcoholic mom. This gives the treatment provider a naturally occurring place to begin. As Carol bonds with her therapist in the work of resolving the pain of her childhood, the therapist can help her examine the significance of her own alcohol usage. The therapy can be augmented by support groups in which Carol can learn from the experiences of others who come from similar home environments and from other people who have had to struggle with the reality of their own addiction problems. Ongoing assessment will be helpful during this process to monitor her progress and make adjustments in the treatment plan as necessary. For example, if she is unable to refrain from using, has additional alcohol-related social or legal consequences, or becomes non-compliant in the treatment process, it may be necessary to move to a more intensive level of care.

The emotional impact of growing up in an environment that is dominated by the pain and shame of addiction takes many forms and can exert its influence throughout a person’s life. Carol’s DWI can be a gift. With appropriate intervention, Carol can begin a process of self-examination and growth that will lead to a freer, richer life.

PDF Version Available for Download

Foundational Story Psychotherapy Webinar

We are happy to announce the next in our line of Professional Development webinars: Foundational Story Psychotherapy: Understanding and Co-Changing Clients’ Stories (Part 1) presented by Dr. Hugh Marr. Below is additional information on this workshop:

We humans are narrative creatures. Much of our communication, our cognition, our memory, and even our understanding of our self is storied. By late adolescence virtually all of us have developed a life story, a story that helps determine what we expect from others, in which settings we are most comfortable, how we treat ourselves and what we can hope for. Our life story is comprised of smaller vignettes or foundational stories. As a result, the coin of psychotherapy is narrative, and clients tell an average of 4.1 stories in each session.

Despite the ubiquity of narrative, most of us receive very little education in the structure of narrative and its application to substance abuse and mental health counseling. Given our narrative bones, all therapies must deal with narrative, although most of them do so implicitly, focusing on only a limited number of aspects of story.

In this workshop, we will examine the narrative underpinnings of substance abuse counseling and psychotherapy; and we will broaden our understanding and use of different approaches to alter both foundational and life narratives. We will look at the special impact of trauma on clients’ life stories and the resultant substance abuse and emotional struggles. Participants will come away with greater ease and more tools to understand and help clients change the problematic stories they live.

This workshop is designed to enable participants to:

  • Define foundational and life stories and describe the relationship between the two
  • Gather and use client’s stories to help them understand and change substance abuse and emotional problems
  • Describe the importance of witnessing and demonstrate thematic listening
  • Identify the relationship among substance use, mental illness, and trauma
  • Describe one use of story-based ritual to assist therapists in creating healthy boundaries between work life and home life

Visit www.sassi.com/other-training-online for registration information, provides 4 CEs. 

We Want to Hear From YOU!

Here at The SASSI Institute we pride ourselves on the work we do to provide validated instruments that help you, as well as your clients.  To do an even better job, we are asking for your feedback.  We want to know how our instruments support your work.  But we also want to hear how we can improve our tools.  Our new Feedback Form gives you an outlet to share your ideas and critiques. 

Click here to complete the feedback form.

If you have a heartwarming experience you would like to share about how our instrument has helped you or a client, we would love to hear that too.  Please feel free to share your story* with us at blog@sassi.com.

*Please exclude identifying client information from the submission

New Professional Development Webinars Available

The SASSI Institute is pleased to announce that we are launching a line of Professional Development webinars. We will be doing these in partnership with guest lecturers on topics that may be of interest to professionals in the addiction field.

Our first such webinar is Comprehensive Screening & Advanced Assessment of Addiction presented by Dr. Don Osborne. Below is additional information on this workshop:

The Screening and assessment processes are critical to effective addiction treatment. In fact, treatment can only be as effective as the thoroughness of the assessment process. The screening and assessment processes can and should result in clients’ reduced denial or “resistance” and easily transition into therapy.

In this training program you will be able to:

  • Understand screening and assessment.
  • Be able to describe a comprehensive concept of addiction’s progressive nature with problems, tolerance and loss of control.
  • Be able to determine the kinds of questions to ask a client that are most relevant during an initial interview.
  • Be able to formulate specific relevant questions to ask during the interview process.
  • How to use Motivational Interviewing to engage clients and develop a rapport with them.
  • How to obtain collateral information about the client.
  • How to use the DSM-5’s criteria for SUD to diagnose clients and decrease clients’ resistance to treatment.
  • Gaining clients’ trust, reduce denial and resistance to treatment.
  • Gain clients’ agreement that they are addicted to some substance or behavior at a particular stage of the addiction process.
  • How to determine the specific level of care advocated by ASAM.
  • How to transition from screening to the assessment to the therapy stages of treatment.

Visit www.sassi.com/other-training-online/ for registration information, provides 4 CEUs. 

Criminal Justice Publication Accepted

Hello friends and colleagues,

We hope you and your families are all doing well. We wanted to call your attention to our very latest peer reviewed publication, released earlier this month. The title is: Criminal Justice Alcohol and Drug Screening in Practice: Using the Substance Abuse Subtle Screening Inventory to Identify Substance Use Disorder in Offenders.

Now in its fourth iteration (SASSI-4), this article discusses the SASSI screening tools’ utility with criminal offenders and reviews a case study of a young male’s clinical evaluation while incarcerated. While SUD is not the only contributing factor to criminality, it significantly increases the likelihood of legal infraction and violations, placing these individuals at a higher risk of re-offending. Thus, identifying SUD as early as possible in the clinical relationship helps provide tailored treatment to those who need it, while simultaneously reducing the risk of future legal difficulties.

For this case study, we reviewed the SASSI-4 screening results of a 24-year-old male. The case presents an excellent example of the value of early identification of substance use disorder and potential problems in criminal justice settings.

We hope you enjoy the article, and as always, we look forward to your submissions and comments.

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.

PDF Version Available for Download

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.

PDF Version Available for Download

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