Tag: Substance Use Disorder

Client’s High SAT Score Indicates Lack of Awareness

Bob is a 43-year old male who was referred by his attorney for a substance evaluation following a traffic fatality in which he was driving under the influence. Bob seems to have understood the items and responded in a meaningful way (RAP = 0). There is no significant evidence that Bob was defensive (DEF = 7).

The most salient feature of the profile is the significantly elevated SAT score, which is a key feature in both decision rules that lead to a test positive on the SASSI (Decision Rules 4, 5, 6, and 7). His responses were highly similar to substance dependent individuals regardless of their ability or willingness to report symptoms relevant to substance misuse. Given the lack of evidence of defensive responding, it’s likely that Bob falls in the category of those who are unaware of the full impact of substance use problems in their lives.

Individuals with this configuration of scores are often willing to acknowledge some behavioral problems related to their substance use. Bob demonstrates this by acknowledging significant current and/or past alcohol (FVA=14) and drug (FVOD=12) use. His pattern of responding also indicates some awareness of behavioral problems that are commonly associated with individuals with substance use disorders: low frustration tolerance, self-centeredness, grandiosity, etc. (OAT=7). However, given the elevated SAT, he will most likely not be able to make any connection between his acknowledged use and behavioral problems and their impact on other areas of his life.

He also responds in a fashion similar to individuals who live in an environment dominated by substance abuse (SYM=6). Although the SYM is not extremely elevated, it does tend to support the notion that Mr. B. may view his substance use as normal. Further content analysis may reveal additional factors about his life circumstances that might be important to consider in treatment planning.

Bob may be relatively well presented. He may also appear to be emotionally detached while maintaining a sense of pragmatism regarding his situation. Relatively poor insight and self-awareness are commonly present in these types of profiles. It’s not that Bob refuses to understand or is intentionally resistant; he literally doesn’t grasp that his substance use may be a problem that requires further exploration. In his mind, external factors or stressors may be to blame for his current predicament. The possibility that this tragic incident may be directly related to a substance use problem would be quite difficult for Bob to understand at this time.

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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,

SASSI Results Highlight Excessive Drug Use Including Rx Abuse

Angela T. illustrates a profile often seen in people who acknowledge that they use drugs excessively and have come to rely on them as a coping resource.

Angela’s scores on the SASSI-4 meet the criteria for classifying her as having a high probability of a substance use disorder. Angela’s score on the Rx scale also indicates a high probability of prescription drug abuse.

Reviewing her scale scores reveals openness in disclosing her use of drugs and alcohol. On FVOD and SYM, Angela acknowledges extensive use of drugs and many negative consequences and symptoms of abuse. Examining her answers to specific items on these scales may help you counsel Angela, and may suggest good starting points for a more detailed history of her use of alcohol, drugs and prescription medications.

On SYM Angela acknowledges serious substance misuse that she acknowledges resulted in making her problems worse, increased tolerance, excessive use, and wishing she could cut down her use of substances. Her OAT score is in the average range, which can indicate that Angela does not necessarily align herself with those characteristics associated with substance abusers and she may not see herself as a ‘drug addict.’

With her Prescription Drug scale (Rx) score of 6, it is useful to look at those individual items as well.

Angela’s moderate DEF score suggests she can be open and realistic in acknowledging her difficulties and substance misuse. The rest of her scores fall within the normal range, between the 15th and 85th percentiles.

Given Angela’s high level of drug use and consequences, you might consider a more comprehensive evaluation to determine whether she can maintain sobriety and function well enough to benefit from a treatment program. She may need supervised detoxification or other intensive intervention.

You may find Angela able to acknowledge that she uses drugs frequently and perhaps that she drinks to excess. However, she may not see that her behavior varies dramatically from others who don’t have a substance use disorder. Feedback on where her scores fall on the profile sheet may help her see that her behaviors are not typical. Examining the items that Angela endorsed on the FVA, FVOD, SYM, and Rx scales may provide useful insight into her motivations for using and help her see the consequences that result from her use. Angela may need your help to acknowledge her pain and to recognize that there are alternatives to her current lifestyle.

The SASSI-4 screens for Substance Use Disorder (SUD) along the full DSM-5 continuum of severity: mild, moderate, and severe. A brief scale, Prescription Drug (Rx), was added to accurately identify individuals likely to be abusing prescription medications. Read a full sample assessment report on Angela T. in the SASSI-4 User Guide & Manual.

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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.

Adolescent SASSI-A3 Available December 1st, 2020

Our Team at the Institute has been working tirelessly on a two-year research project to bring you an updated adolescent instrument that is validated against the DSM-5 diagnostic criteria.  Our research has produced multiple publications and allowed the SASSI-A3 to include some new features, including a brief scale, Prescription Drug (Rx), to accurately identify teens likely to be abusing prescription medications. The updated version also includes new subtle items to reflect current teen alcohol and drug use patterns, as well as several updated questions using contemporary teen verbiage, and additional Face Valid items to identify symptoms in the DSM-5.  The instrument also distinguishes likely Substance Use Disorder (SUD) from other psychological disorders; thus, the SASSI-A3 can accurately identify the presence and the absence of SUD, even when other psychological symptoms are present.

The SASSI-A3 will be available through SASSI Online immediately upon release and SASSI Online users can begin using it immediately on December 1st.  Paper & Pencil product will be available for pre-order starting November 1st, with our first shipment of SASSI-A3 product/s scheduled for December 4th.  After December 1st, the Adolescent SASSI-A2 Paper & Pencil material will remain available for purchase for a limited time, or while supplies last. 

Hope Remains: Attacking some of the Veiled COVID-19 Challenges

This has been an interesting year hasn’t it? I’ve worked in the behavioral health field, primarily substance use disorder, since 1989. During those 31 years I’ve never come across the types of challenges I’ve seen this year, for those struggling with substance addiction and for those healthcare providers trying to help them.

“Social isolation” is the new mantra in the culture and yet it is the very thing that is anathema to behavioral health counselors trying to help individuals coping with addiction. Resources are going out of business and events which once brought enjoyment, support, solidarity and an alternative to substances for having fun are being cancelled one after another. Fear is paramount, and it’s drastically shaping the face of addiction and recovery. We are seeing more initiation of substance abuse, more cycles of relapse and overdose, and more barriers to successful recovery in order to cope with a world in chaos. While outpatient treatment programs have successfully used technology to transition to online counseling groups, this has presented a barrier for those without the resources to purchase the technology needed to participate. For the last 10 years, I’ve worked for a local non-profit treatment center for women and adolescent girls here in Dallas, Texas called Nexus Recovery Center. Recently, the Executive Director, Heather Ormand, wrote the following in a blog post:

“COVID-19 has stripped so many sober women of our community. Twelve-step meetings are no longer being held in churches.  Churches are closed or access is limited and people are afraid to sit shoulder to shoulder right now. For those with long-term sobriety and a strong support system, we can probably get by with Zoom twelve-step meetings, reading literature and connecting with other sober women via text or calls. But what about the woman struggling in her disease? The woman isolated in an unsafe home without the resources to leave and get treatment? The woman without a place for her children to go while she tries to piece together continuous days of sobriety and start rebuilding their lives?”

But there is hope. Treatment staff have proven that they are indeed essential, and programs like those at Nexus Recovery Center are showing that recovery staff are willing to risk getting sick themselves in order to help another human being break the cycle of addiction. They are showing that empathy and compassion and hope can still be conveyed through a mask or through a live, online group or individual counseling session. We can still find innovative ways to connect and share our experience, strength and hope with those who are struggling to find someone who cares.

I’ve also been associated with The SASSI Institute as a trainer for the past 25+ years and have found them to be an organization that strives hard to give agencies effective and easy to use resources for helping identify individuals struggling with a substance use disorder and guiding them to the most appropriate path for their recovery journey. I’m also proud to have been allowed to help people on The SASSI Institute’s Clinical Helpline for the past few years. One consistent thing I hear from callers is how much they appreciate the fact that they can reach out in frustration or puzzlement over a client they are working with, and how those on the Clinical Helpline are always there to help them work through a SASSI screening result, craft how to phrase the results to the client or in a report, and guide them in helping clients discover things about themselves, in order to initiate their recovery process. The SASSI Institute, though at a “social distance,” is there for me like a warm blanket on a cold night and for many other behavioral health workers in the US and in other countries who sometimes just need a willing ear to process some of their cases and SASSI results. Working together we can get through 2020 and beyond, despite any obstacles.

Coming Soon: Adolescent SASSI-A3

               We wanted to provide you some important SASSI updates. We’re excited to announce that the research findings on the adolescent SASSI-A3 have been published! Within the coming weeks and next few months, we will be concentrating our efforts on publishing the SASSI-A3 instrument, which similarly to the adult screening tool, now includes a prescription drug scale and greater sensitivity to opioids and prescription medications. The updated instrument will be available on our online platform immediately on the release date. We will provide additional details and pre-ordering information as soon as we have a confirmed availability date. You can read the published finding here: Validity of the Adolescent Substance Abuse Screening Inventory-3 (SASSI-A3). We also expect to publish other manuscripts examining co-occurring disorders among some of these adolescents; and the increase and dangers of Vaping as a drug source for them and adults, which has increased dramatically in recent years. These manuscripts are in submission and we hope to have them published by year end as well.

On another note, despite wonderful advances in securing possible cures and vaccines, COVID-19 clinical trials, and worldwide collaboratives to address this virus, the unfortunate reality is that the case numbers continue to climb and sadly, the death toll continues to rise. This has forced many states and local governments, and even the federal government, to change well thought initiatives and plans, and even back-track on some of the openings and relaxing of public health statutes. As a result, many private practitioners and even some long-standing programs have had to continue furloughing operations, or sadly cease operating altogether. With even greater sadness, we have heard multiple reports from the substance abuse, treatment, and correctional field/s about the loss of family, colleagues and friends to this devastating disease, and our hearts and prayers continue to go out to their families.

The SASSI Institute remains committed to helping you stay connected and feel supported during this period of uncertainty. We will be informing you of developments as they occur on our end. But for now, please accept heartfelt wishes from all of us, that you and your families remain safe.                                   

We will get through this together!

#alonetogether

Notes from the Clinical Director: Clinical Interpretations

One of the trickier aspects of incorporating the SASSI results in a substance use assessment is extracting the clinical interpretation of what elevated scores mean and the relationship between the scales. If you have taken SASSI training, especially the Clinical Interpretation session, you were introduced to ‘Profile Configurations.’ This section gets more in-depth into interpreting the scales and clinically drawing on information that can better inform how to work with your client as well as consideration of treatment modalities.

Starting with the Face Valid Alcohol and Other Drug Scales versus Subtle Scales, which when one of those is elevated can make a big difference on how you approach your client with the results. A high probability result based on only Face Valid scales can indicate good treatment readiness, life-style issues (that is, how they are functioning at work, school, home, etc. and been acknowledged by the client), with behavioral consequences being greater than psychological addiction. The client can readily tell you how their life has become unmanageable. With this client, group therapy and/or support groups could be considered.

A high probability result based only on Subtle Scales is going to feel more like a brick wall. The client exhibits less awareness and may not be able to, or doesn’t want to acknowledge a problem. This could be based on having experienced only a few negative consequences so they do not feel the impact of their addiction. They could also come across as defensive. Finally, they could be ‘sincerely deluded’ and at this point, unable to connect the dots for themselves. This client will need a lot of support to become aware that their use of substances is having an impact on their life functioning. Individual therapy may be the initial therapeutic intervention working towards other modalities as needed.

If you have attended Session II of SASSI Training, you received an outline of scale interpretation. But we would like to make sure all SASSI users have access to this valuable resource. You can download a copy by clicking the following link: “SASSI Scales in Interpretation & Feedback.”

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 888-297-2774 or 800-726-0526, press 2.

Adult SASSI-4 Substance Use Disorder Screening Accuracy with Criminal Offenders

The Substance Abuse Subtle Screening Inventory (SASSI) has been used successfully in correctional screening in multiple settings since its release. These include outpatient evaluations of offenders as well as assessments of incarcerated individuals in federal, state, and local correctional centers.

Many clients served in behavioral health and substance abuse treatment programs have histories of involvement with the criminal justice system in addition to mental health and substance use disorders. Samples in the SASSI-4 validation study included assessments in community corrections, probation and parole and drug courts, as well as cases from DWI and DOT education and screening programs. SASSI-4 overall screening accuracy in criminal justice settings was 95%; in DWI and DOT education programs SUD screening accuracy was 91%, and these accuracy levels were found not to differ significantly from the overall accuracy rate for all settings (92%). In addition, many cases included routine information on clients’ number and types of arrests and blood alcohol levels. Analyses revealed that SASSI-4 screening accuracy was 92% for clients with a history of criminal offenses, and 90% for clients who had no such histories.[i]

Interestingly, of those who had been diagnosed with a substance use disorder, criminal offenders acknowledged significantly less illicit drug use and consequences as well as less alcohol use and consequences on the SASSI-4 face valid scales than did clients with diagnosed substance use disorders in settings other than criminal justice programs — suggesting offenders minimized reported use and substance-related problems. By contrast, offenders with substance use disorders showed no differences in their endorsements of subtle items on the SASSI-4 compared to individuals with substance use disorders in other types of assessment settings. Despite offenders’ attempts at minimization, SASSI-4 overall accuracy in the offender samples was 94%. Together these findings illustrate strengths of using SASSI-4 to screen criminal offenders as compared to entirely face valid screens such as the AUDIT, CAGE or DAST. That is, the inclusion of subtle items on the SASSI-4 as well as a scale to identify clients’ level of defensive responding strengthens the ability of the SASSI-4 to accurately identify clients with substance use disorders.

In addition to legal offenses and possible substance use disorders, offenders also often have other mental health problems, which can affect their responses on many types of assessments they are given. Research on the SASSI-4 has shown its screening sensitivity is 98% in dual diagnosis clients; specificity is 93% in persons diagnosed with nonsubstance-related psychological disorders only, for an overall accuracy rate of 97% in people suffering from other psychological disorders. Moreover, accuracy was shown to be unaffected by ethnic background, and other demographic variables such as age and education.

For information on integrating the SASSI-4 into correctional programs, contact us at 800.726.0526.

[i] For additional validation information please refer to: Lazowski, L.E. (2016). Estimates of the reliability and criterion validity of the Adult SASSI-4. Springville, IN: The SASSI Institute.

Download PDF: Criminal Offenders and the SASSI-4