We want clinicians to find the SASSI to be helpful in their work in a way that enables them to affect the lives of their clients in a positive manner.
When a client is unable to acknowledge (sincerely deluded) or unwilling to accept they may have a problem, a clinician’s skillful and caring feedback on SASSI results may help break through those barriers and enable the client to take the courageous step toward recovery.
If you would like to learn more about clinically interpreting SASSI profiles, we encourage you to join us for one of Clinical Interpretation trainings. For more information on live, on-demand, and in-person workshops, please visit https://sassi.com/sassi-training/
Free assistance interpreting SASSI results is available M-F 1-5 pm ET at 800.726-0526 Option 2.
The following profile result is of a 35-year-old male referred for screening and possible assessment after a drug-related arrest. He completed the FVA/FVOD side of the questionnaire based on his entire life timeframe. His RAP score was 0, indicating no random responding and that the result should be valid. His Prescription Drug Scale score (Rx) was 1, so he did not meet the cutoff for High Probability of Prescription Drug Abuse.
Looking at this profile, we see that he was classified as high probability of a substance use disorder based on the following Decision Rules:
Decision Rule 1 with a FVOD score of 32.
Decision Rule 3 with an OAT score of 9.
Decision Rule 4 with a SAT score of 14.
Decision Rule 5 with a SYM score of 6 (5 or more) and a SAT score of 14 (4 or more).
Decision Rule 7 with an OAT score of 9 (7 or more) and a SAT score of 14 (6 or more).
Looking at the graph on the SASSI Adult Male Profile sheet, we see an extremely high elevation on the FVOD scale score which is significantly above the 98th percentile. Individuals who score this high on the FVOD are able to acknowledge currently having or having had numerous negative consequences and problems as a result of their use of drugs. This can include loss of control of the drug use as well as using a coping mechanism. It is important to note that, since he was asked to use the “entire life” timeframe for the FVA and FVOD scales, his admission of having these consequences and problems with drugs may be related to some time in his past and not necessarily currently. For example, the client’s score on the SYM scale (which is similar to the FVA/FVOD in what it is measuring), is not nearly as elevated as his score on the FVOD even though the questions are not that dissimilar from the FVOD questions.
This suggests that he is not showing as much acknowledgement on the SYM scale of the symptoms of substance misuse that he admitted to on the FVOD scale. This could be related to the fact that the SYM scale (like all scales on the True/False side of the questionnaire) has no specific timeframe associated with it and therefore the client may have the belief that, while he has had significant problems with drugs in the past, he may not believe his current drug use is as much of a problem currently. It is highly recommended that clinicians do a content analysis of the client’s answers to the FVOD and SYM scale questions as this will provide more insight into the client’s acknowledged problems with drugs.
This client’s elevated OAT scale score, like the elevated FVOD scale score, suggests a capacity to acknowledge and identify with many of the typical negative attributes (general personality and behavioral characteristics) and personal limitations that are often common among those with substance use disorders – e.g. impatience, resentment, self-pity, impulsiveness). While the client can often see these “character defects”, they may not always feel motivated to change them or feel capable of changing. Given that the OAT score in this case is above the 98th percentile, it is highly probable that this individual may be able to closely identify with individuals in recovery from substance use disorder, such as those found at recovery support groups, and therefore may be more willing to trust these recovering individuals and follow their recovery advice.
The client’s highly elevated SAT score (the highest score on this profile), which is higher on the graph than the OAT score, suggests that despite the client’s capacity to acknowledge the more obvious problems and negative consequences associated with his use of drugs, there are subtle aspects of his behavior, personality, and addiction that are extremely hard for him to acknowledge. In other words, he may not be able recognize the pervasiveness of his addiction, how it negatively affects and rules every aspect of his life with deeply held negative thinking patterns, beliefs and negative coping patterns driving his addictive behaviors.
Clients with a pattern of scores like this client who tend to be able to acknowledge heavy usage, negative consequences and problem behaviors, may still be convinced, sincerely deluded into thinking that they are not truly addicted. They will often present as more “superficial” saying things like “well, I go to work every day and do my job so I couldn’t be addicted”. Clients with elevated SAT scores (especially higher on the graph than their OAT score) tend to be more initially resistant to the need for treatment and are more likely to relapse. These clients tend to be detached from their feelings and have relatively little insight into the basis and causes of their problems (namely substance addiction). These clients typically need a more intensive level of treatment where they can receive constant support for their recovery efforts and can get the kind of group processing therapy needed to help them connect with their feelings and learn how to cope with them without drugs.
In providing treatment to this type of client it is important to recognize that underneath the many excuses (other than substance addiction) for their problems, there is an individual with a substance use disorder who is likely in pain and scared. Individuals with high SAT scores may not be in touch with the pain and fear, largely because they immediately numb any negative feelings with substances as soon as they appear, but the pain and fear. In this case, intensive treatment and group work has to be accompanied by sensitive and skillful clinical intervention that lets the individual know that somebody is aware of their fear deep within and that it will be a relief to let it out to begin healing.
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).
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.
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.
The message this Adolescent was trying to send is as confused as he must be. A lot of contradictions in the numbers needed to be sorted out and made sense of.
This 16-year-old male responded to the FVA and FVOD questions for his whole lifetime.
The Prescription Drug Scale result was zero.
The VAL check was 4.
He met the criteria for a High Probability of a Substance Use Disorder based on Rules 1, 5, 6 and 7. A reminder, it requires only 1 yes to the 8 rules to meet the criteria for High Probability. More “yes’s” does not mean a more severe problem. Severity of a Substance Use Disorder is determined with a diagnosis from the DSM-5.
Another reminder, content analysis of the Face Valid scales i.e. FVA, FVOD, FRISK, ATT, SYM and Rx individual items can be examined to generate information regarding under what circumstances substances are used and with whom, along with underlying emotional reasons.
The FVA of 7 is elevated enough to meet the criteria of Rule 1. The FVOD of 2 is below average and within the norm.
The FRISK score of 0 proves to be interesting given the context of the psychosocial history of this individual. It may be he did not want to disclose information regarding his friends or family.
The ATT score of 6 is highly elevated above the 98th percentile. This indicates he has a strong value and belief system regarding the use of substances. He may believe that everyone uses and that may be the case in his world.
The SYM score of 3 is within the norm so from his perspective, he has experienced minimal symptoms or consequences of his usage.
The OAT score of 7 is elevated above the 85th percentile so clinically significant but coupled with an higher SAT score of 6 as graphed is somewhat muted. On the one hand, an elevated OAT score indicates he can acknowledge personal limitations and shortcomings and may identify with other substance users though he may not want to change. On the other hand, the elevated SAT score can indicate denial or lack of awareness and insight or detachment from feelings.
The DEF score of 6 is within the norm and below average which can indicate self-esteem issues. It is a bit surprising the DEF score, in this case, is not elevated. The client was not defensive completing this questionnaire.
The SAM score, by itself, has no clinical interpretation.
The COR score of 5 is within the norm so there is no clinical interpretation.
What the psychosocial interview revealed: The client had a history of vaping nicotine with friends and had completed a Substance Use Education course. However, the client was smoking pot at home and minimizing his use. He was described as lying and manipulative. It was also disclosed his father is in recovery. As we all know, attitudes around Marijuana not being addictive or even a “drug” have been rapidly changing along with the legalization of Marijuana. However, the client’s risk of developing a significant risk of a substance use disorder is escalated by a family history of addiction.
Addressing the VAL score of 4: With the High Probability of a Substance Use Disorder result, the VAL check score does NOT come into play. It would only be impactful if he had come up with a LOW Probability of a SUD. However, this score is quite high, and the administrator would rightly suspect the client was trying to skew the results even if it had no impact on the result.
We welcome you to join us for a free one-hour online SASSI Q&A session hosted by our Clinical Director, David Helton, LMSW, LCDC. Whether you’re new to the SASSI, considering using the SASSI, or a seasoned veteran at screening with the SASSI, everyone is welcome. The Q&A is scheduled from Noon-1pm ET on: November 12th. You can save your spot by clicking here. We welcome you to share profiles to discuss with the group by sending them (de-identified) via email any time prior to the session to scarlett@sassi.com. These profiles will help others learn about the SASSI and offer insight into the various profile configurations.
Note: Q&A sessions do not provide CEUs and are not a substitute for SASSI Training.
In our last blog post we discussed a frequent question we get regarding the web-based version of the SASSI-4 and how to identify the SYM (Symptoms) scale items on a client’s completed questionnaire. This week we discuss identifying the FRISK (Family-Friends Risk), ATT (Attitudes), and SYM scale items on the web-based version of the Adolescent SASSI-A3. Because these scales are face valid, they can give you information concerning the client’s substance use and it may be worthwhile to do a content analysis of the items comprising them as they are directly related to substance use.
While logged into your sassionline.com account, click on the tab ‘My Clients’ and then click on ‘Support Materials.’ On the Support Materials page click on ‘SASSI-A3 User Guide.’ Go to pages 15-18 for the information on these scales. There you will see the 6 FRISK items, 8 ATT items, and the 19 SYM items listed. We suggest you print these pages out to assist in identifying these items on your clients’ completed questionnaires.
As always, we encourage you to call our free clinical help line for interpretation assistance M-F 1-5 pm EST at 800.726.0526 Option 2.
A frequent question we get is regarding the web-based version of the SASSI-4 and how to identify the SYM (Symptoms) scale items on a client’s completed questionnaire. Because the SYM items are face valid they can give you information concerning the client’s substance use and it may be worthwhile to do a content analysis of the SYM items as they directly relate to substance use.
While logged into your sassionline.com account, click on the tab ‘My Clients’ and then click on ‘Support Materials.’ On the Support Materials page click on ‘SASSI-4 User Guide.’ Go to page 19 for the information on SYM. There you will see the 20 SYM items listed. We suggest you print this page out to assist in identifying the SYM items on your clients’ completed questionnaires.
As always, we encourage you to call our free clinical help line for interpretation assistance at 800.726.0526 Option 2.
This SASSI-4 profile is an excellent example of why the comprehensive assessment is a crucial part of the evaluation process.
This 33-year-old male completed the FVA/FVOD side of the questionnaire for his whole lifetime.
His RAP is 0 as is his Prescription Drug Scale.
His profile graphs most of his scores within the norm, between the 15th and 85th percentiles. The one standout is the SAT score of 0. That score indicates someone who is hypersensitive to what others think about him and may harbor feelings of resentment coming across as having a chip on his shoulder. Although the DEF score of 7 is not quite high enough to trigger looking at the possibility of SASSI missing individuals with a substance use disorder, it is significantly above average so there may be a “hint” of him exhibiting defensiveness.
Based on the face of it and on the SASSI alone, he comes up with a Low Probability of a Substance Disorder.
So, what is missing? The information gathered from the rest of his evaluation.
This individual has a history of 3 DUI’s – one in 2013, 2020 and the last in 2023.
As you can see, he does not indicate in his FVA or SYM any issues with alcohol or negative consequences of his usage. From his perspective, he has not had negative consequences. It could be that what he was required to do historically was minimal i.e. an alcohol education class. As these offenses are spread over 10 years, it may mean that he has a problem with drinking and driving. What is his current usage? Does he have a diagnosable disorder based on the DSM-5? Knowing about his extensive history requires the Clinician to dig deeper into this client’s use history and question his perspectives.
A useful tool we offer for both individual administration and for alcohol-related education and treatment interventions is the BADDS – Behaviors & Attitudes Drinking and Driving Scale.
It identifies drinking and driving and riding behaviors, history of impaired driving, the likelihood of riding or driving with an impaired driver, rationalizations for drinking and driving and intervention effectiveness.
The BADDS can be used in Driver’s education classes, Impaired driving prevention, DUI courts and DUI programs, Colleges and Universities and Counseling and treatment programs.
The BADDS can be used as a pre-test or be re-administered to measure behavioral and/or attitudinal change in multiple intervals. The post-test can also assess overall program effectiveness.
The BADDS is available in a paper and pencil version only for those 18 years or older with a third grade reading level and takes about 15 minutes to administer. We do offer on-demand webinar training. For more information go to www.thebadds.com.
Did you know that SASSI screening tools are available for use and are obtainable through our international distributors? If you are in, or have friends/colleagues in the UK, Australia, or Greece, please take note of our licensed distributors there for affordable access to SASSI screening tools.
In the UK, the paper & pencil version of the adult SASSI-4 and adolescent SASSI-A3 is available through SASSI Direct Ltd. For ordering information please email sassi@sassidirect.co.uk.
In Australia, the paper & pencil version of the adult SASSI-4 and adolescent SASSI-A3 is available through The Help Now Group. Since purchasing the web-based version of the SASSI through SASSI Online can be challenging for our Australian colleagues due to issues with credit card processing, access and administrations of the web-based version can also be purchased through The Help Now Group. For ordering information please email rodney@thehelpnow.org.
In Greece, a reliable and validated version of the translated adult SASSI-3 in Greek is available through Panagiota Kontoleon. For ordering information please email panagiota@kontoleon.com.gr.
We are pleased that these distributors are working with us to promote screening for those individuals suffering from substance use-related issues and disorders.
