‘Reggie’ is a 37-year-old married man. He and his wife have two children. He works as a warehouse worker where he was recently injured in a shipping dock accident. He recently returned to work after being on worker’s comp for several months during which time he was prescribed opioids for his pain. He was sent to his employer’s EAP provider for evaluation after returning to work and struggling with coping with the continued pain and poor job performance.
Reggie T’s responses illustrate another profile often seen in people who acknowledge that they use drugs excessively and that it negatively impacts on their functioning and relationships.
Given Reggie’s high level of drug use and consequences, you might consider a more comprehensive evaluation to determine whether he may need supervised detoxification or other intensive intervention.
You may find Reggie ready to acknowledge that he uses drugs frequently and that he may also drink too much. However, he may not see that his behavior varies dramatically from others who don’t have a substance use disorder. Feedback on where his scores fall on the profile sheet may help him see that his behaviors are not typical. It may be useful to know that Reggie’s wife is currently in treatment for drug and alcohol abuse due to a DUI. Their mutual abuse of substances may help promote their beliefs that their substance use is normal. Examining the items that Reggie endorsed on the FVA, FVOD, SYM and Rx scales may provide useful insight into his motivations for using and help him see the consequences that result from his use.
In this first video watch Reggie’s initial EAP visit in which he was asked to take the SASSI.
This second video is the follow-up session where he discusses his SASSI results with the EAP provider.
We regularly get inquiries about the acceptability of reading the questionnaire to a client who may have difficulty with their reading skills. We discourage the evaluator from reading the questionnaire to the client for a variety of reasons, but the primary one concerns the validity of the results. No matter how careful the reader might be, the tone of voice or emphasis on a particular part of the question may lead the client in one direction or another. Or the client may interrupt with a question regarding the meaning of a word or intention of a particular question. This is why we offer a professionally read audio CD of the SASSI-4, Adolescent SASSI-A3 and Spanish SASSI paper and pencil versions for clients who have reading difficulties. We hope in the future to be able to offer this for the online platform as well. Please contact our customer service department for ordering information.
Another frequent question is related to the clinical interpretations of the “low” scores on the profiles. These mostly relate to the subtle scales which include the OAT, SAT, DEF and SAM scales. Most callers know what a low DEF indicates. And SAM has no clinical interpretation.
So what about those low OAT and SAT scales? What does “low’ mean? A low score is anything below the 15th percentile on the graph. In the example to the right, the caller indicated that she was doing an assessment on a health care professional who had been arrested for her one and only DWI the previous year, had completed her alcohol education class and needed this evaluation as a final step for probation. She was not in trouble in her job and in fact, highly regarded in her profession. Given the client was at the end of her requirements, the evaluator was somewhat concerned with the results and what it meant. The instructions were given to answer the FVA/FVOD side for the last twelve months. Her RAP is zero. Her Prescription Drug Scale is zero. She has ‘no’ on all the rules so came up with a Low Probability of having a Substance Use Disorder. However, her DEF of 9 is highly elevated. Elevated DEF scores increase the possibility of the SASSI missing individuals with a substance use disorder. Elevated DEF may also reflect situational factors. Note that the SAM is within the norm so it is probably more likely that her DEF is situational given the context. She also has an OAT score of ‘O’ and a SAT score of ‘2’. Both are below the 15th percentile. A low OAT indicates someone has difficulty acknowledging personal limitations or shortcomings. A low SAT indicates someone who might have a ‘chip’ on her shoulder, a hypersensitivity to others or feelings of rejection.
So even though this client is nearing the completion of her probation requirements, we still get a picture of someone who is highly guarded (DEF), has a hard time acknowledging shortcomings (OAT) and may continue to exhibit resentment (SAT) for the situation she is in. Perhaps this is due to her profession, or perhaps it is her personality. What the results give the evaluator is clinical direction on how to approach the client to help reduce her defensiveness and give her permission to open up. Affirming how demanding her job is and how on top of things she must be could be a pathway to discussing her feelings of shame related to the DWI and how it might be affecting her self-esteem. Could she be minimizing her use of alcohol and drugs? Perhaps, but as we strongly express, the SASSI is only one part of a clinician’s assessment. Hopefully, with the input of all the information you have, the clinician can evaluate the results which fit the context for this client.
Last month, Dr. Hugh Marr, a longtime trainer on the SASSI and clinical psychologist in the private practice of psychotherapy in the Washington, DC area gave an interview on the Shrink Rap Radio podcast. Dr. Marr has taught both substance abuse counseling and psychotherapy at area universities; and has worked in all phases of community mental health, culminating in running a partial hospital program for clients with the co-occurring disorders of substance use and major mental illness. He is the author of A Clinician’s Guide to Foundational Story Psychotherapy: Co-changing Narratives, Co-changing Lives (Routledge, 2020); and the coauthor of the books What Story Are You Living? (CAPT, 2009) and Introduction to Archetypes (CAPT, 2002). His forthcoming workbook for a general audience, also to be published by CAPT, will be titled Finding Your Story. You can view a clip from that interview here or a link to the interview in its entirety can be found here.
The SASSI Institute is excited that Dr. Marr has developed a workshop based on his five-star rated book: A Clinician’s Guide to Foundational Story Psychotherapy: Co-changing Narratives, Co-changing Lives. This workshop is being offered through The SASSI Institute’s Professional Development Platform. A link to a flyer with additional information on the workshop can be viewed here.
We hope you enjoy the interview and that you will join us for this informative webinar.
The SASSI-4 I am reviewing is interesting for what it is not.
The client was instructed to complete the FVA/FVOD for the last 12 months. The client is a 34 year old male with a history of drug and alcohol use. He reports that two and a half years ago he successfully completed treatment. He stopped doing drugs but continues to consume alcohol. He was being evaluated by the order of the court for an “altercation with his ex-spouse”. He does meet multiple rules and comes up with a high probability of a substance use disorder. Remember the number of Rules met does not mean a more significant disorder. The diagnosis is based on the DSM-5 with the designation of mild, moderate or severe based on the number of symptoms met.
As seen on the profile sheet, he has a number of elevated scales including the FVA, SYM, OAT, SAT and COR. What is interesting, is that his DEF is not elevated and is below average staying within the norm. For domestic violence cases, this is fairly unusual. Often we see an elevated DEF above the 85th percentile. The FVA and SYM scores indicate an openness and acknowledgment of his use as well as symptoms and consequences. The elevated SYM also indicates he is either hanging out with or from a family of heavy users. In this case, he disclosed his family has a history of alcohol abuse.
The elevated OAT score indicates that he can probably identify with other substance users and those behaviors we often see with substance abusers i.e. impatience, resentment, self-pity and impulsiveness. On the other hand, his elevated SAT indicates a lack of awareness or insight or simple denial of the impact alcohol is having on him. He readily acknowledges his past drug issues but has put alcohol in a separate category. His final elevated scale is COR. Regardless of any past or present legal issues, we encourage evaluating for those behaviors that impact the ability to make good choices. These behaviors can range from poor social skills, low frustration tolerance, risk-taking behaviors to impulse control or anger management issues.
Utilizing the results: The evaluation started out as a domestic violence case but transitioned to also include substance use. The fact that the client was open about his alcohol use, not defensive and has a successful treatment history suggests he may be willing to take a look at his alcohol use and its impact on his behavior. His elevated OAT score does indicate treatment readiness and he is not going to feel out of place in a group setting. The emphasis will be to help him connect the dots between his alcohol use and any impulsive behaviors. This does not take the place of any recommended intervention for anger management issues he may have. The administrator has a good opportunity to facilitate the client to continue the work needed on his recovery and deal with all his issues.
We hope this is helpful for you in your work with your clients. As usual, the free clinical helpline is open for your questions M-F, 11-5, (EST). Don’t hesitate to call us whether you are new to the SASSI or an old hand.
For more than a year now, our lives have been literally turned upside down. Many of us have lost loved ones and friends or had them severely affected by this terrible pandemic. It has caused upheavals in basically all areas of our lives.
But I think it is safe to say that we are finally turning the corner. Science tells us that the required herd immunities and vaccinations are soon to be at optimal levels. Here at The SASSI Institute, we are at more than 95% capacity. And I am so proud of our staff, their dedication and professionalism as they continued to serve you, the heart of our business. They were with you through thick and thin, and despite the multiple obstacles, collectively we accomplished an extraordinary level of achievements throughout this time. For example, we have multiple publications that are now in the public domain. Please contact our Customer Service Team if you are interested in any of them, they are free of charge. If interested in our Training services and availabilities, contact our Training Director Ms. Scarlett Baker, or our Executive Assistant, Ms. Lauren Nelson. Kristin Kimmell LMSW, LCAC, our Clinical Director and her team are available for any of your clinical concerns. And by the way, Lauren also serves as our IT specialist, so she is available for any mishaps in your IT service provision.
In sum, I am very proud of you, our customers for maintaining our collaborations, our staff for making that possible, and to the many, many individuals we serve, may their path to recovery be enlightened by your services.
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.
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
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.
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
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.
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.
