Tag: Substance Use Disorder Screening Instrument

Adolescent SASSI-A3 Review: High Probability Result with a VAL of 6

This adolescent male profile presents some initial complications for the reviewer in regards to the clinical interpretation as seen on the graph. The face valid scales fall either within the norm or below the norm. One of the subtle scales is above the 85th percentile so is clinically significant, and another is below the norm. An examination of the scales produces useful information to guide the discussion of the results with the client and directing appropriate treatment considerations.

This 17-year-old male completed the FVA/FVOD side of the questionnaire for his whole lifetime.

The VAL is 6.

Rx Scale is 0.

High Probability of a Substance Use Disorder is based on Rule 6.

Rule 6: a. FVOD 7 or more. (8)

            b. FRISK or ATT or SYM is 3 or more. (SYM – 3).

            c. OAT 5 or more (7).

Clinical Discussion

The FVOD of 8 is above average and should be noted. Examining those particular questions, he endorsed will provide the groundwork for how and under what circumstance he is using drugs. With the FRISK (0) and ATT (1) scores so low, his use is not necessarily tied to his peers, nor does he have a belief or value system that supports the idea that everyone uses substances. Looking at his one ATT score will help to evaluate any beliefs he may hold around substances.

The SYM (3) score is above average and again, because it is a face valid scale, content analysis will provide information regarding the consequences that he does acknowledge.

The OAT (7) scale is significant because it is elevated above the 85th percentile. This is the subtle scale that you want elevated as it indicates someone who can acknowledge limitations and shortcomings. He can probably identify with other substance users and those behaviors represented in that population such as impatience, resentment, self-pity, or impulsiveness. This, of course, does not mean he wants to or believes that he can change. But this information can be used as a positive to recognize the insights he may have around his use.

The low SAT (1) score (below the 15th percentile) gives some clues on how best to approach this client. This score indicates he is very hypersensitive to what others think about him. He may come across as having a chip on his shoulder so tread lightly!

The DEF (8) score, though above average, is still within the norm so does not indicate significant defensiveness on the client’s part.

The SAM (3) and COR (3) have no clinical significance.

Does the VAL score of 6 impact the results? Given the outcome was High Probability based on Rule 6, the impact is nil. The VAL is significant only if the outcome was Low Probability. However, with that score, the evaluator may hypothesize that perhaps the client was trying to skew the results but failed.

Questions remain regarding the current use of substances by the client. Is he minimizing his use or is he presenting an accurate picture? He was not defensive so perhaps his overriding concern was how he was viewed by the evaluator.

Treatment Considerations

Recommendations for the level of treatment need to be considered if he does have a diagnosable disorder based on the DSM-5. Actual current use also needs to be established. The elevated OAT score does indicate he will not feel out of place in a group setting. Prior history of substance use issues also need to be considered. It would appear, however, that outpatient treatment would be a consideration with the level of intervention to be determined by the overall assessment.

We recommend administrators of the SASSI have access to The Adolescent SASSI-A3 User Guide and Manual. It contains information on scoring, interpreting profiles and includes examples of profiles. It defines all the scales, what they represent, clinical considerations and giving feedback. The Manual also contains the research and validation information. Please call our Customer Service number for more information on how to order – 800-726-0526.

PDF Version Available for Download

Another Public Health Threat: The Extensive Use of Bromazolam

We recently published a commentary in Public Health Open Journal regarding Bromazolam (fake Xanax) use. It is increasingly being found in the illicit drug supply, mixed with other drugs like fentanyl and heroin, among others. Within the commentary, we examine the current state of the science as it pertains to the public health dangers of Bromazolam and its various illicit distribution networks, not only in North America but across the world. We also examine possible directions the substance use disorder (SUD) field may undertake to address the proliferation and abuse of this substance along with overdose prevention efforts that include the public health dangers of Bromazolam use. 

We invite you to download this free commentary to read and share with your friends, family, and colleagues. 

Yet Another Public Health Threat: A Commentary and Examination of the Extensive Use of Bromazolam  

Upcoming Clinical Q&A and Live Online SASSI Training | Register Now!

We wanted to remind you about our free one-hour online SASSI Q&A sessions hosted by our Clinical Director, Kristin Kimmell, LCSW, LCAC.

We love hearing about how you are using the SASSI and answering your questions about our screening tools. We currently have three more FREE Q&As scheduled from Noon-1pm ET on: February 13th, March 12th, & April 16th. You can save your spot by clicking here. We welcome you to share profiles to discuss with the group, please send them (de-identified) via email any time prior to the session to scarlett@sassi.com. These profiles help others learn about the SASSI and offer insight into the various profile configurations. If you are a SASSI Online (www.sassionline.com) user, we have a LIVE certified SASSI training webinar for Session 1: Administration & Scoring of the web-based version of the SASSI scheduled for February 6th and Session 2: Clinical Interpretation on February 20th. Each session is 9am-1:30pm ET and costs only $60 USD per session. You can register by clicking here.

Note that the Q&A sessions do not provide CEUs and are not a substitute for SASSI Training. SASSI training provides 3.5 NAADAC CEUs per session or you can choose 3.5 TCBAP (for Texas professionals) or CACCF (for Canada professionals) CEUs.

Adult SASSI-4 Review: Does the SASSI evaluate for Video Gaming?

This is an interesting profile on a 23-year-old male as it brought up the question, we get on the helpline regarding video gaming. “Does the SASSI evaluate for video gaming addiction?”, especially if the administrator believes the client was possibly including video gaming as well as substance use in his answers. The simple answer is no, it does not, so please clarify with your client not to include video gaming.  A drug that is often associated with video gaming is Adderall so the follow-up question to a client who admits to excessive video gaming is to question what drugs are they using to maintain that level of energy and concentration.

This individual was instructed to complete the FVA/FVOD side of the questionnaire for the last 12 months.

RAP was 0.

High Probability of a Substance Use Disorder.

Prescription Drug Scale result was 3 so meets the cutoff for High Probability of Prescription Drug Abuse.

He met Rule 1 with a FVOD score of 21.

             Rule 2 with a SYM score of 7.

             Rule 4 with a SYM score of 5 (7) or more and a SAT score of 4 (7) or more.

Looking at the graph on the Profile sheet, you will see a significant elevation on the FVOD scale score – above the 98th% so he is openly acknowledging use of drugs. By analyzing his responses, you will gain insight into what circumstances he is using, including dealing with emotional or stressful issues. And remember, he is answering the FVOD questions based on the last 12 months.

The SYM elevation is above the 85th percentile – enough to meet Rule 2. Because SYM is a face valid scale, you can do content analysis on those questions to look at the symptoms and consequences of his substance use.

The OAT score is within the norm. It would probably be the case that he does not identify with other substance abusers. This may be related to his very low-DEF score.

The SAT score is within the norm but high. The administrator may pick up some denial or lack of insight on the part of the client. And again, it may be related to the DEF score.

The DEF score is very significant because it is so low, below the 15th percentile. This individual may be in emotional distress and may be suffering from depressive symptoms. He should be evaluated for depression as he may be using substances to self-medicate. He may also believe that if he wasn’t depressed, he would not be abusing substances thus the OAT and SAT scores may reflect this perception.

The Rx score is also very significant and warrants further investigation as to what prescription drugs he may be abusing and if, in fact, are related to video gaming.

The rest of the scores are within the norm, so not clinically significant.

In summary, these clinical results are hypotheses to explore with the client to determine the depth and scope of the client’s use in order to recommend a treatment plan which fits his particular needs.

We hope this is helpful to you.

The clinical helpline line is open for your inquiries, M-F, 12- 5 (EST) at 888-297-2774 and you will be directed to a clinical consultant. If we are not available, please leave a message and we will return your call.

And as always, Thank you for your interest in the SASSI.

PDF Version Available for Download

Year-End Message from the CEO

Another year has come and gone. It honestly feels like only yesterday that we planned our 2023 journey, that it is now nearly over. As in years past, I would like to recognize all of us that have lost loved ones, friends, or colleagues. In honor of their suffering and loss, we continue to offer our condolences, our understanding, our compassion, and our love. Unbelievingly it seems that as every new year dawns upon us, new and deadlier substances cross our paths.

This past year we examined one of those, Xylazine, an especially dangerous and deadly substance. We also reviewed the additional difficulties and stigma our recovering LGBTQIA friends and colleagues endure as they attempt to fight the deadly consequences and sequalae of the many years (sometimes decades) that they succumbed to during their addictions. To those that have suffered, strained, and fought endlessly, yet maintained their sobriety we offer our deepest congratulations. We also examined sustained recovery and how those successfully demonstrated their fortitude and strengths as they learned to live their lives one day at a time, drug and alcohol free. But importantly, we also recognize that meeting people where they are at, in their journey is the most important assistance we can provide. Judgement free, we must remember that we are responsible only for the effort and recognize that there are no failures. Even recovery attempts should be celebrated.         

In the meantime, our Board of Directors, senior management staff and myself, want to reassure you that we will continue in our quest to provide you with the help and support you may need as you help those less fortunate than ourselves. We are all experiencing increased economic pressures and an uncertain economic environment, but I want to assure you that all of our departments remain united in our efforts to continue to provide you with the materials and support you need. As we have said before there are no words sufficient to thank you for the work you do, the struggles you engage in to help those less fortunate than ourselves. For that and so many more reasons, we at The SASSI Institute share our thanks!

In short, we want you to always consider us your allies as you help your clients. Remember we are only a phone call, text or email message away. Stay safe and may you all have a joyous and healthy holiday season and New Year.

Warm regards,

Explaining Results to a Client with a High Probability Result When Scale Scores are Within the Norm

Perplexed callers periodically raise the question of how to interpret the results to their clients when all the scores fall within the norm and are only one standard deviation above or below the T-score of 50. Clinical interpretation is minimal although you can glean some useful information than just reporting a high probability.

The following profile result is of a 48-year-old female. She completed the FVA/FVOD side of the questionnaire for the last 12 months. Her RAP score was 0. Her Prescription Drug Scale score was 4 which indicates a High Probability of Prescription Drug Abuse.

As you can see, her FVA of 2 indicates below average use of alcohol, her FVOD score of 8 indicates above average use of drugs though within the norm. Her SYM score of 4 is also within the norm and although above average, she is not endorsing a lot of negative symptoms or consequences of her usage. Content analysis is useful with the Face Valid scales because they will give the context or conditions of how the client is using substances. The OAT score of 4 is within the norm so one hypothesis to explore, given the High Probability of a Substance Use disorder result, is if this client identifies with other addicted folks and those issues we often see in that population i.e. self-pity, resentment, low frustration tolerance, impatience etc. I would suspect not.

The SAT score of 3 is well below average although within the norm, this client may be concerned with what you think about her.  The DEF scale score of 7 is above average but also within the norm so you may be picking up a bit of a defensive posture with this client.

The last 3 scales, SAM, FAM and COR have no clinical impact.

Moving onto the Rules, two rules are met: Rule 9 and Rule 10.

Rule 9

  • FVA 6 or more or FVOD is 4 or more
  • SAT is 3 or more
  • DEF is 7 or more
  • All three, a,b, c ?  YES

Rule 10

  • FVA is 14 or more or FVOD is 8 or more
  • SAT is 1 or more
  • DEF is 4 or more
  • SAM is 4 or more
  • All four, a,b,c, d ? YES

The Rules are research based. Single scores within one standard deviation above or below the normative scores for each scale are not likely to indicate strong evidence of a diagnosable substance use disorder or a clinical problem. However, validation research indicated that some combinations of scores within this normative range such as in Rules 9 and 10 were evidenced by people who were diagnosed with a substance use disorder, and yet this same pattern of scores was not evidenced by those without substance use disorders. The scoring rules identify patterns of scores that accurately and reliably identify individuals with substance use disorders- even when the individual scores in the rule are not indicative of SUD on their own. Also, Table 10 in Chapter 7 in the SASSI-4 User Guide & Manual shows that both Rules 9 and 10 have a 96% accuracy rate indicating that the rules rarely identify people who do NOT have an SUD as positive on these rules.

You can see for Rules 1-4, the cutoff scores are outside the standard deviation which allows for both meeting the rule criteria and allows for easier clinical interpretation as well.

It is also important to note that the cutoff scores for each scale in any rule are specific to the rule. Being close doesn’t count.

Giving feedback to this client, the administrator needs to be aware of the bit of defensiveness and sensitivity of the client and perhaps the reluctance to identify as an addict. Using the information, she did endorse in the FVA, FVOD and SYM scales along with the Prescription Drug Scale results. It may help her to connect the dots and thus become open to whatever treatment considerations are discussed.

As always, if you have any questions about your SASSI results, please contact us through the free Clinical Helpline. We are available M-F, 12 – 5 EST at 888-297-2774 or 800-726-0526.

PDF Version Available for Download

Adolescent A3 – Emphasis on COR Scale

This profile is a good example of needing to be careful with assumptions.

Overview of CORRECTIONAL (COR) SCALE

The COR scale provides information pertaining to the possibility that the client may have a relatively high risk of experiencing legal problems. It is composed of items that differentiated between people who had a history of involvement in the juvenile justice system and those who did not.

It is very important not to over-interpret elevated COR scores. Teens who have elevated COR scores are responding similarly to individuals who have violated the law. This does not mean that all clients with elevated COR scores have broken laws. Also, there is no empirical evidence that these clients are at risk for future offenses.

If a client has an elevated COR score, it is worth exploring those behaviors which may be leading the client to make poor choices, especially after using substances and magnifying the tendency to exhibit those behaviors. These include anger management issues, impulsivity, risk taking behaviors, low frustration tolerance or poor social skills. The task of the clinician is to help the client see the relationship of their behavior to the consequences they have experienced and introduce alternatives to regulate their emotions and behavior.

The SASSI A3 was administered on a 15-year-old male and the time frame for the FVA/FVOD was for the past 6 months. The caller explained this time frame was used as the client identified that his substance use became problematic during this time. He indicated he had initially started smoking marijuana but in the last 6 months started abusing Percocet.

There is a lot to look at in this profile below.

He meets Rules 1, 3, 4, 5, 6 and 8 so met the criteria of a High Probability of having a Substance Use Disorder. A reminder that more “yeses” does not necessarily mean a more severe problem or meets the DSM-5 criteria for severity.

His Rx scale score was 1.

The FVA (2) is below average and within the norm.

The FVOD (18) is highly elevated and close to the 98th percentile so he is very open about his use and under what circumstances he is using.

As seen on the profile graph, both the FRISK (2) and ATT (3) are within the norm though above average.  These scores indicate he is not necessarily using due to peer pressure nor does he have a strong belief or value system that endorses substance use.

The SYM (9) is off the chart. He is endorsing negative consequences and symptoms of his use as well as loss of control.

It is worth taking the time to look at how he has answered his face valid scales and do content analysis of his answers because these will generate a lot of information for clinical insight and discussion on how and why he is using substances. As a reminder, the face valid scales are the FVA, FVOD, FRISK, ATT, SYM and Rx scales. You cannot do content analysis on the subtle scales.

Both the OAT (8) and SAT (7) are above the 85th percentile. Although the OAT indicates he can acknowledge personal limitations, the higher SAT score indicates a level of denial or lack of awareness or detachment from feelings and may present himself functioning well.

The DEF (4) score is very significant as it is below the 15th percentile. This indicates severe emotional pain, and he may be exhibiting depressive symptoms so it is suggested a mental status exam should be conducted.

As usual, there is no individual clinical interpretation to SAM (4).

The last scale, COR (10) is highly elevated above the 98th percentile. He is identifying with those issues that are normally seen in juveniles with legal issues.

This is where one must be careful with assumptions because this client has had no legal issues for any reason. It is more productive to explore those issues he is identifying with and affecting his choice making.

It is also curious that one can be very open (based on the FVOD and SYM) yet have an elevated SAT score as well. This may be due to the DEF score and the emotional pain he is in. Hypothetically, he may believe that if he was not “depressed” he would not be abusing drugs.

Another aspect of the profile is to explore his Rx result. According to the client’s report, he is primarily abusing Percocet. His score may reflect he is getting it illicitly and not through a doctor.

Finally, regarding treatment considerations, the caller reported he has tried to quit using the Percocet for a week but relapsed. A treatment plan including inpatient should be considered considering his reported relapse.

We hope this is helpful to you.

The clinical helpline line is open for your inquiries, M-F, 12- 5 (EST) at 888-297-2774 and you will be directed to a clinical consultant. If we are not available, please leave a message and we will return your call.

And as always, Thank you for your interest in the SASSI.

PDF Version Available for Download

Upcoming Clinical Q&A | Register Now!

We wanted to let you know that we are still offering our free one-hour online Clinical Q&A sessions hosted by our Clinical Director, Kristin Kimmell, LCSW, LCAC.

We enjoy hearing how you are using the SASSI in your clinical practice and agencies as well as answering your questions. We currently have three more free Q&As coming up this year. You can reserve your spot and view available dates and times by clicking here. If you have profiles you would like to share with the group for discussion, please send them (de-identified) via email any time prior to the session to scarlett@sassi.com. Your contributions would be of great value.

Also, a reminder that we have a live certified SASSI training webinar on Administration & Scoring of the paper & pencil version of the SASSI on November 28th and Clinical Interpretation on December 5th. You can register by clicking here.

Note that the Q&A sessions do not provide CEUs and are not a substitute for SASSI Training. SASSI training provides 3.5 NAADAC CEs per session.

We hope to see you there!

The SASSI in Community Corrections

The Substance Abuse Subtle Screening Inventory (SASSI) is a valuable tool used in various contexts, including community corrections programs. When used in community corrections settings, the SASSI serves several important purposes:

  1. Screening for Substance Use Disorders (SUDs): One of the primary functions of the SASSI in community corrections is to screen individuals under supervision for potential substance use disorders. It helps probation and parole officers identify clients who may be struggling with substance abuse issues.
  2. Risk Assessment and Management: The SASSI provides valuable information about the level of risk that an individual poses in terms of problems related to their substance use. This information helps community corrections officers make informed decisions about supervision levels and interventions. For clients with co-occurring substance use and criminal justice issues, the SASSI helps community corrections officers manage risk more effectively.
  3. Treatment Planning: For individuals identified as having substance use issues, the SASSI results can inform the development of individualized treatment plans. It can help determine the appropriate type and intensity of substance abuse treatment needed to address the client’s specific needs.
  4. Referrals: If the SASSI identifies a client as having a high likelihood of a substance use disorder, community corrections officers can make referrals to specialized substance abuse treatment programs or other appropriate services.
  5. Resource Allocation: The SASSI results can help allocate limited resources within community corrections programs more effectively. As a result, officers can prioritize clients with higher substance abuse risk for more intensive interventions.
  6. Compliance and Accountability: Incorporating the SASSI screening tool into community corrections programs can enhance client accountability and motivation to get treatment, especially among clients who may be unaware or sincerely deluded about their substance use issues.
  7. Documentation and Reporting: The use of the SASSI screening tool in community corrections ensures that evaluations are conducted in a standardized and systematic manner, which is essential for documentation, reporting, and legal compliance.

It’s crucial to note that the SASSI should be administered by professionals who understand the nuances of substance use screening and the ethical considerations involved. Additionally, confidentiality is an important aspect of using the SASSI in a community corrections context, as clients’ rights and privacy must always be protected.

SASSI Online Tips and Tricks: Volume 6 | Inviting Additional Counselors

SASSI Online is our web-based platform that supports the digital administration of the Adult SASSI-4, Adolescent SASSI-A3, and Spanish SASSI. It provides a report with interpretive paragraphs outlining the decision rules and results from client responses.

In this edition of SASSI Online Tips and Tricks we review the steps to add multiples counselors to a SASSI Online account, manage their invitation, and how to manage their access.

Only the Primary Clinical Contact (PCC) for an organization can invite other counselors to the account, by clicking the “My Account” tab, then clicking the “Invite Counselor to Register” button, and then the “Invite New Counselor” button. An email with a SASSI Online link will be sent to the counselor which invites them to register. When sending an invitation, keep in mind that Invitations can be filtered by spam/junk protections. If the invitation is not in the counselor’s junk or spam folder the link is available on the same screen you clicked “Invite New Counselor.” Locate the affected counselor in the invitation history list.  Click the “Resend” button, a window will show the counselor’s unique registration link. You can copy this link and send it directly to the counselor for registration.

Since the PCC is required to be qualified, the invited counselor is administering under their supervision. However, they will still be prompted to complete a qualification form during registration.

Additional counselors added to the account cannot see the reports of other counselors or those of the PCC.  However, the PCC does have access to all counselor’s reports through their dashboard on the Admin tab. Sharing of reports among counselors can be done by printing, or saving and sending.  It is also acceptable to upload the client’s PDF results to an organization’s electronic health records system.

If an added counselor or counselors are no longer with your organization, they can be deactivated.  Deactivation removes their ability to login to the account but retains their client records.  To deactivate a counselor, email the request to sassi@sassi.com.

If you are not currently using SASSI Online and would like to experience the features of the digital platform, create an account at www.sassionline.com.  If you already have an account, let us know if you have any suggestions for our next edition of SASSI Online Tips and Tricks.  As a bonus for reading this blog post to the end, reach out to us at blog@sassi.com, with the code phrase: Adding Counselors, to request two free SASSI Online administrations!