Tag: Screening for Substance Abuse

Why Looking Beneath the Surface Matters in Screening

The Science of Face Valid vs. Subtle Items

In the world of substance use assessment, there is a recurring challenge: the “Honesty Gap.” When a client enters a screening environment, whether due to a court order, workplace requirement, or personal crisis—they are often operating under extreme pressure. This pressure frequently manifests as denial or purposeful concealment.

The Limitation of Direct Questioning: Most screening tools rely almost exclusively on “face valid” items. These are questions where the intent is obvious, such as “How many times a week do you use stimulants?” While these questions are necessary, they are easily manipulated. A client who is not yet ready to change, or who fears the consequences of their answers, will likely underreport.

The SASSI Advantage: Subtle Scales The SASSI-4 (Subtle Substance Abuse Screening Inventory) is unique because it utilizes subtle items. These are questions that do not appear to be related to substance use on the surface, but are statistically correlated with individuals who have been diagnosed with Substance Use Disorders (SUD).

By integrating these subtle scales, the SASSI provides a “safety net” for the clinician. If a client’s face-valid scores are low but their subtle scores are high, it usually indicates a high probability of a substance use disorder based on the SASSI decision rules despite the client’s current inability or unwillingness to acknowledge it.

Clinical Application This isn’t about “tricking” the client. Instead, it’s about providing the clinician with a more accurate roadmap. Knowing that a client is defensive or in denial allows you to adjust your clinical approach—providing an opportunity for more open dialogue rather than immediate confrontation—thereby increasing the chances of long-term treatment retention.

Understanding SASSI Scales

Participants in our Clinical Interpretation (Session 2) of SASSI Training learn about screening and assessment information; giving client feedback; and practice interpretation using SASSI profiles. Upon completion of the session, participants should feel comfortable making clinical interpretations from both the adult SASSI-4 & adolescent SASSI-A3 scales and using the SASSI to engage the client in the treatment process.

Feedback to clients on SASSI profiles is useful in increasing awareness, eliciting further information, and establishing rapport. Presenting the results of the decision rules and discussing scale scores can help people come to grips with the significance of their substance usage and identify treatment goals.

The following is a link to a handout provided in the Clinical Interpretation Session that you are welcome to download for reference when interpreting profile: SASSI SCALES: CLINICAL FEEDBACK.

We encourage you to attend the Clinical Interpretation Session 2 of SASSI training if you have not already and to utilize our free Clinical phone line for consultation and help interpreting profiles at 800.726.0526 Option 2.

The Need for and Usefulness of the SASSI

Substance use disorders cause problems for countless individuals and society as a whole. Alcohol and drug abuse often underlie difficulties presented as emotional, medical, family, school, or legal problems. These problems are not likely to be resolved until the underlying substance use problem is dealt with. Yet many affected individuals are unable or unwilling to acknowledge their misuse of psychoactive substances, and many human service providers lack the resources to conduct comprehensive diagnostic assessments for substance use disorders on every client in their practices.

Dr. Glenn A. Miller developed the SASSI in response to the need for a screening measure that could identify individuals with a high probability of having a substance use disorder, even if those individuals do not acknowledge substance misuse or symptoms associated with it.

The SASSI is brief, easy to administer, and objectively scored. A client can answer the questionnaire in less than fifteen minutes. The SASSI can be scored and interpreted in a minute or two.

Thus, clients with a high probability of having a substance use disorder can be identified and helped by employee assistance programs, vocational counselors, psychotherapists, medical personnel, criminal justice programs, and other human service providers.

The SASSI is used by human service practitioners throughout the United States and Canada, as well as other countries and is used to help over a million people every year. For information on the accuracy of our screening tools please visit https://sassi.com/reliability-validity/.

Extracted from: 
Lazowski, L. E., Kimmell, K.S., & Baker, S.L. (2016). The Adult Substance Abuse Subtle Screening Inventory-4 (SASSI-4) User Guide & Manual. Springville, IN: The SASSI Institute. 

Opportunity for Experienced SASSI Users

If you enjoy sharing knowledge and have an enthusiasm for the SASSI, we invite you to consider becoming a certified SASSI trainer. We are looking for individuals to offer live in-person trainings to the public (open trainers) in their state/province of residence and possibly surrounding states/provinces, as well as individuals to provide training for their organization’s staff and their satellite offices (closed trainers).

Open trainers charge a fee to participants and advertise their training to the public (placement on SASSI website is provided). Closed trainers do not advertise to the public and do not collect a registration fee for providing the training. Both types of trainers can issue certificates of attendance with continuing education credits and all materials needed to provide training are sent at no cost.

Qualifications for trainers are as follows:

  • At least five years of experience in addictions or mental health counseling
  • Experience in assessment, group work, teaching, or workshop presentation
  • Experience using the SASSI, having screened at least 20 clients with it
  • Good verbal communication skills
  • Education: College degree or advanced degree or certification as a substance abuse professional
  • Experience in psychometrics helpful, but not required

Procedures for obtaining open trainer certification can be found here and closed trainer certification here. Please reply to scarlett@sassi.com with any questions or to apply.

Reviewing an Adolescent SASSI-A3: Vaping Issue

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.

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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

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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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,

Adolescent Vaping: Examining the Dangers

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.