The SASSI Institute is proud to announce our newest manuscript addressing adolescent substance abuse. The title of this article is Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial. It provides an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers. Part of the data set we collected for The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3, the present study focused on data from 164 mandated teens that participated in the principal study. As in the principal study, these cases were drawn from substance use treatment, criminal justice programs, community corrections, and private clinical practices, among other venues, and all cases were provided by clinicians working within these service settings throughout all U.S. Census Regions. In addition, we review cases demonstrating high-levels of defensiveness and denial in these mandated teen clients, and ethical ways to break through that barrier towards effective treatment engagement. Finally, we present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. We at The SASSI Institute are very proud of this work, and I want to personally thank my co-authors for making this work possible. The article is available free of charge as it was submitted as an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows readers to copy, redistribute, remix, transform, and reproduce in any medium or format, as long as the original authors are properly cited.
We want to take this opportunity to inform you of a small questionnaire we are deploying in the coming weeks. We’d really appreciate your feedback and we’d like as many of you as possible to take the time to fill out this brief anonymous form. We feel that if we receive enough responses, it will provide us with critical information on how we might better serve your needs when treating your clients. We consider you our collaborators our ‘feet on the ground’ in this ongoing war against substance use disorder. We will provide links to the survey in various ways and consider you input invaluable.
Thank you for your consideration.
Increase your understanding of how drugs of abuse interact with each other as well as what takes place in the brains of experimenters, abusers and addicts. Improve your ability to communicate with medical professionals and your clients.
On March 29th and 31st, 2022, Dr. Donald R. Osborne, Jr., author of the newly released book “You Can’t Fall Out of a Hole: Ripping the Band Aid off of Our Addiction Epidemic,” will be hosting a live webinar to increase your knowledge on the subject of Psychopharmacology and the Biology of Addiction.
Information that will be presented and discussion will be about the following:
|Central Nervous System||Peripheral Nervous System|
|Autonomic Nervous System||Somatic Nervous System|
|Sympathetic Nervous System||Parasympathetic Nervous System|
|How the Brain Works||Tolerance and Cross-Tolerance|
|Rebound / Withdrawal||Drug Half Life / five to eliminate|
|THIQ in Alcohol Metabolism||Dopamine Depletion by Cocaine|
|Determining BAC by number of drinks consumed|
The following drugs/drug classes will be examined:
For each of the drugs/drug classes, the following information will be provided and discussed
- Route of Administration
- Metabolic Half-Life
The webinar will be live from on March 29th, 9:30-1pm ET, and March 31st, 1:30-5pm ET. The webinar will be available on-demand afterwards.
To register, click the date you are interested in below:
This is an issue that may be turning up in your clinical practice. The caller wanted help with a profile interpretation on a 13-year-old male who had turned in a vaping pen. The school was mandated to do a substance use evaluation as a result. The online report indicated “inconsistencies” in the results so the counselor wanted more information. The client was instructed to complete the FVA/FVOD side for his whole lifetime.
The overall result, based on all the rules being ‘no’, came up with a Low Probability of a substance use disorder. The Prescription Drug Scale was zero. However, the Validity Check Scale was 6 so further evaluation was recommended. Elevated VAL and DEF scores coupled with a Low Probability result increases the possibility of the SASSI missing individuals with a substance use disorder.
Looking at the graph on the profile sheet helps to pull out additional information. Note the very low (below the 15th percentile) OAT and SAT scores. The low OAT can indicate someone who has a hard time acknowledging personal limitations or shortcomings. The low SAT can indicate someone who has a chip on their shoulder, feelings of rejection and hypersensitivity to others. Interestingly, the DEF score is within the norm and does not indicate the student was defensive completing the SASSI. The FRISK score is above average but within the norm and because it is a Face-valid scale, content analysis of those items may be useful. The other Face-valid scales, ATT and SYM with their scores of 1 can also be examined.
The student who turned in the vaping pen indicated it was not his. It was not clear from the caller what substances they suspected were being used. Clinically, the best thing to keep in mind is that the student has a hard time opening up and is probably very concerned about how he is viewed by teachers, counselors, etc. and very quick to feel rejected. Interacting with him in an accepting and affirming way is probably the best approach.
Substance use issues: The VAL of 6 is a red flag so further evaluation with this student is warranted. It could be on-going oversight within the school, i.e. school counselor or referral to a Substance Use counselor who could do a more formal and comprehensive assessment.
We hope this is useful for you.
As usual, don’t hesitate to call the Clinical Helpline at 800-726-0626 with any clinical questions. Live clinicians are available M-F, 11-5 pm (EST). Otherwise, feel free to leave a message and we will get back to you the next business day.
One question we field often on the clinical helpline is what does it mean when either the OAT (Obvious Attributes) is higher than the SAT (Subtle Attributes) or when the SAT is higher than the OAT when both are elevated above the 85th percentile?
We hope some of you have been able to participate in at least one of our new Professional Development webinars. We are excited to be able to partner with fellow colleagues in the field of addiction to be able to provide continuing education on professional topics of interest.
We have recently partnered with Courtney Hupp, MSW, LCSW, CADC, an EBT Clinical Coordinator at Chestnut Health Systems in Illinois. She had an active role in the Assertive Continuing Care (ACC) study, funded by NIAAA, in which she administered the ACC and Community Reinforcement Approach (CRA) protocols to residential clients’ post-discharge, as well as supervised other therapists on the study. Courtney will be offering her workshop “Community Reinforcement Approach for Substance Use in Adults” live online through the SASSI Institute’s training platform on February 8th. The treatment model known as CRA recognizes that, at least initially, alcohol and drug use is about reinforcing consequences — that make us more likely to repeat actions. This is true whether we are hanging out with friends, playing a favorite game, eating a good meal, or using alcohol or other drugs. People who use alcohol and drugs get something out of it – or they wouldn’t keep doing it.
The overall goal of CRA is to help individuals reconnect with or discover new sources of positive reinforcement within their community to compete with alcohol or drug use. How do CRA clinicians do this? By listening to and learning from their clients what is important to them. They then help them connect to pro-recovery activities that have meaning and value to their client. In addition, CRA clinicians help their clients identify goals and learn how to achieve them. CRA clients also learn a variety of new skills, such as problem-solving and positive communication (with partners, friends, and others), which help them attain a better quality of life. Practicing new skills is a critical component of the skills training used in CRA. Every session ends with a mutually-agreed upon homework assignment to practice skills learned during sessions. This intervention has been implemented in outpatient, intensive outpatient, and residential treatment settings. This research-tested intervention has been used in over 500 organizations across the United States and Canada. Courtney Hupp will provide an introduction to the CRA model, a summary of the research base, and details about how to use a variety of CRA skills during sessions.
What You Will Learn:
- An Introduction to the CRA model
- History of CRA research and implementation
- Goals of CRA treatment
- An overview of the CRA session structure and treatment guidelines
- How to use some of the CRA procedures during sessions like a Functional Analysis for substance use, Happiness Scale, Sobriety Sampling, and Increasing Prosocial Recreation
- General clinical skills necessary to implement CRA
For registration information click here.
A caller requested help interpreting the result of a SASSI-4 questionnaire on a male client who presented himself as having an opioid addiction.
‘Curtis’ is a 36-year-old married man. He and his wife have no children. He works as a landscaper which he describes as physically very demanding. His parents smoked marijuana while he was growing up and Curtis also smokes marijuana. His older brother died ten years ago, and Curtis is still grieving. His brother also had substance use issues. Curtis also may have a history of being molested as a child which he does not remember, but his brother relayed that they were both molested by a babysitter.
Curtis reports a four-year history of opioid addiction which started as a result of a herniated disc in his back. He was initially prescribed hydrocodone for pain. He tried to quit once three years ago. Currently, he is ordering “stuff off the internet” or getting oxycontin from friends. He has been taking 180 mg/day with a maximum of 240 mg per day. It takes 150 mg. for him not to get “sick.” Curtis continues to smoke marijuana on the weekends about one time per week. He has a legal history of possession of marijuana in 2004 and attended an outpatient treatment program doing “what I had to do.”
He has been slowly tapering off the opioids for the past five weeks and currently is down to 80 mg/day. His goal is to completely get off the opioids but he is not interested in residential treatment at this time because it is his busiest time of year. Although he has attended NA, he does not like it. Curtis is more drawn to Smart Recovery.
The SASSI-4 was administered for lifetime use on the face valid side of the questionnaire.
What were his SASSI-4 results? Curtis has a ‘High Probability of having a Substance Use Disorder’ and a ‘High Probability of Prescription Drug Abuse.’
This looks like a straightforward profile on the face of it. His score of 42 on the FVOD and 18 on the SYM indicate someone who is very open concerning his drug use, and because these are face valid scales, content analysis could provide useful information to further explore with the client.
The OAT score of 6 is right at the 85th percentile. The client may be able to identify with some of the characteristics of substance users such as impatience, resentment, self-pity and impulsiveness. However, the SAT score of 8 is higher than the OAT and may blunt the ability for Curtis to have insight into his behavior. When the SAT is higher than the OAT, the client may exhibit a lack of awareness or simply denial around the impact drugs are having on his life. In this case and not unusual, opioid users do not see themselves as “typical” addicts. That may account for the OAT score.
The DEF score of 2 can be a ‘red-flag’ as it is below the 15th percentile. A score this low can indicate someone with poor ego strength, feeling helpless and hopeless and may be exhibiting symptoms that look like depression. The clinician may want to do a mental health screening or refer the client for screening.
The FAM score of 5 is also very low, below the 15th percentile. This can indicate the client is focused on himself and not that concerned about others. This does not indicate a personality disorder but given the client’s circumstances, makes sense that he would be more internally focused.
The COR score of 8 is elevated above the 85th percentile. He has answered in a similar way to people who have had legal issues for any reason. We suggest screening for those behaviors or characteristics we often see in that population. These can range from poor social skills, low frustration tolerance, risk-taking behaviors, anger management issues or impulse control issues. These issues could be impacting on Curtis’s choice-making abilities.
Finally, looking at the Prescription Drug Scale. With the score of 14, it is quite clear that he is identifying behaviors associated with prescription drug abuse. Again, as a face valid scale, looking at these individual items will generate a lot of information for the clinician. The clinician will need to look at treatment readiness, discuss medication needs, possible referral and other reported clinical issues.
In this season of Thanksgiving, I felt it appropriate to share some of the many things we at The SASSI Institute are thankful for. This past year has demonstrated our human potential and tenacities in so many ways. Despite the over five million worldwide deaths directly attributable to the COVID virus, our healthcare, teaching and service staff, and yes you, all of the treatment and human service professionals throughout the world have demonstrated that we may have been down, and maybe down again, but we always get back up. There are indeed so many of us that have lost loved ones, friends, or colleagues. Our hearts go out to them. In honor of their suffering and loss, we offer our condolences, our understanding, and our love.
But the proverbial light is there. We can finally see what may be an end to this horrific pandemic. Thanks to the scientific community and healthcare workers throughout the world, we are finally seeing a reduction in case numbers, and hopefully soon, our ability to declare a finality to this dire and deadly disease. If nothing else, it has proven we are all one people, and that our unity truly stands stronger than any divisiveness. Through it all, we have managed to be there for one another, for our friends, colleagues, and our families. We have remained united, and that is and should continue to be foremost in all our minds, and meriting of our thankfulness.
In the meantime, our Board of Directors, senior management staff, and I want to reassure you that despite the multiple supply chain issues, inflationary pressures, and uncertain economic environment, we have once again decided this year to maintain our pricing structure such as it is. We at The SASSI Institute are doing our best to allow you, our licensees, and collaborators to continue to do your jobs, offer the many services you offer, and continue to assist those that need us the most, those still suffering through substance use, co-morbidities and in some cases along with COVID and other health issues, tri-morbidities. This year has also seen many changes in our operational structures and the various features we offer here at The Institute. I am extremely proud of our staff and the non-stop work they have executed this year. Our Training Director has overseen one of our most successful initiatives, The Professional Development Workshops series. In addition to the many trainings we have offered over the years, we now also have nationally recognized experts providing Continuing Education approved training related to substance use disorders, co-occurring disorders, and the incorporation of our SASSI tools in assessment packages for specialized populations. Our customer service, clinical, and IT teams as always, remain at your disposal and are providing non-stop services to facilitate your administration and interpretation of our many tools. I anticipate several other exciting initiatives to come, and we will inform you of them as they develop.
In the meantime, be kind to yourselves, and let’s make it our mission to take care of each other, and most of all let’s remember to be thankful!
If you have attended one of our trainings either in-person or online, you know the section on how to administer the SASSI to a client is one of the most important. A thoughtful approach can set the tone for the entire assessment by helping a client feel more at ease and engaged in the treatment process. We emphasize the importance of first establishing rapport with the client. The questionnaire is presented as an aid, not a test with right or wrong answers. We instruct to administer the true/false side first, then checking the appropriate time frame for the face valid side. Letting the client know s/he will have a chance to discuss the results at a later time increases the client’s comfort level.
Our protocol is based on the recommended one-on-one consultation. We realize that is not always possible. Administrators of the SASSI work in a variety of settings including schools, probation departments, EAP, treatment agencies, institutions and private practice. Since the SASSI does not require a professional to administer it, a variety of personnel can be trained, but both the context and the administrator can have a significant impact on the receptivity of the client.
This example of the context of a SASSI given to a client dramatically shows the difference the setting can make in the results. One of our clinicians fielded this call. The administrator did not know which results to use even though both profiles came up with a high probability of having a Substance Use Disorder.
The client is a 46-year-old male who was given the SASSI at the Courthouse in a packet of material he was instructed to complete. Two weeks later he was given another SASSI to complete. This time with a counselor assigned to evaluate him.
Here are the results of the first SASSI he completed at the Courthouse:
As you can see, he meets Decision Rule # 9. Looking at the graph, some scales and numbers stand out. On his face valid scales, including SYM, his numbers were within the norm, between the 15th and 85th percentile. His OAT score is extremely low which indicates he has a hard time acknowledging personal limitations or shortcomings and may have difficulty in groups. The other significant score is the DEF score of 8. In spite of the elevated DEF score, he did meet one rule. The SAM is almost at the 85th percentile so, in my mind, I might be more inclined to say he was defensive about his substance use and perhaps minimizing on the face valid scales. This hypothesis would depend on the rest of the assessment with any additional information. However, he was given the SASSI to complete within a packet of materials, and it is very unclear what instructions he was given, if any, on how to complete the SASSI.
Let’s look at the results of the 2nd administration given just two weeks later in the office of the counselor who was evaluating him after meeting and talking with the counselor.
In this profile, the client meets multiple decision rules including numbers 3, 4, 5, 6, 7 and 10. All it takes is one rule to meet high probability and more than one does not mean a more severe substance use disorder. Diagnosis and severity are based on the DSM-5 criteria. It is evident his raw scores have changed to impact the decision rule results.
There is a significant change in his Face Valid Scales with an FVA of 11 and an FVOD of 14. His SYM score of 6 also shows elevation. OAT has changed from a 0 to a 9. He is now indicating a willingness to acknowledge shortcomings and limitations. In addition, he probably can identify with other substance abusers so a referral to a group treatment program can be considered.
The significant drop in the DEF score from an 8 to a 5 is nice to see. The client met with the counselor who was able to establish rapport by making the client more comfortable and explaining what the SASSI is and how it will be used in the context of the assessment. The low FAM score reflects the client’s internal state of mind. He is probably very concerned about what is going on within himself and not so concerned about others.
The final interesting scale change is the COR score and probably more representative of the client’s self- assessment at this point. Perhaps he is more able to identify impulsive or anger management issues, risk-taking behaviors, low frustration issues, or poor social skills. It gives the counselor some insight on what to explore, regarding behaviors which are impacting the client’s choices.
The most important difference in these two profiles was how the SASSI was presented to the client. Context, and establishing rapport can produce a more useful SASSI by obtaining a depth of clinical information. As an aside, we were not informed on why the SASSI was administered twice within a two-week time frame. We do not usually recommend doing so. It may have been the counselor was unaware of the first SASSI administration until receiving the completed materials from probation.
We hope you find this useful information regarding clinical issues. As always, the Clinical Helpline at 888-297-2774 is open to serve you Monday through Friday, 9 am to 5 pm (EST).
Many of our SASSI trainers and other instructors have expressed a desire to get their boots back on the ground and start offering live in-person, hands on workshops again. While we have all been adapting to with what has become a new social norm of online training, webinars, and conference events, many have decided that they are ready to embrace in-person events again.
If you have a group that you would like to discuss arranging a live on-site SASSI Training for, please let us know. You can reach us at firstname.lastname@example.org and we can have the trainer/s in your area reach out to you for planning. You can also find a list of available trainers and their contact information at https://sassi.com/sassi-training-us/ and https://sassi.com/sassi-training-canada/. As always, training online for groups and individuals is available.
We also offer professional development webinars on various topics found at https://sassi.com/other-training-online/. On the top of that page there is a link to complete a form to request a quote for a private in-person or online training.
Stay safe and be well.