Tag: Substance Use Screening Inventory

SASSI

Use of The SASSI in Identifying Factors in Crime and Criminal Recidivism

Although there have been ample demonstrations of the value of rehabilitation programs for criminal offenders, it is important to recognize that recidivism in the criminal justice system remains a serious problem.

It would be an easy matter to greatly reduce the incarcerated population if one and only one factor caused people to have multiple arrests. Substance Use Disorder (SUD) is a strong common element among repeat offenders. However, there are numerous other factors that can also lead to habitual legal offensives – impulse control problems, personality disorders, psychiatric disorders, cognitive impairment, chronic stress, a history of trauma, childhood and other developmental issues, peer culture, poor social skills, etc.

No single factor necessarily causes criminality, but each one can contribute to a tendency toward law violation, and they can combine to produce a high-risk profile. Because there are multiple causes of criminality, one treatment program may be of value for some repeat offenders but still does not address all the issues that need to be addressed to prevent further legal difficulties. Repeat offenders do not come from one mold. Therefore, one given course of treatment is not likely to be maximally effective for all recidivists.

Screening to Identify Risk

The challenge of early intervention is to find a means of identifying and addressing risk. A first step in reducing recidivism in the criminal justice system is to screen legal offenders to identify individuals who are at greatest risk for ongoing legal difficulties and who are likely to have an SUD to provide them with appropriate and timely treatment.

SUD is strongly related to legal problems. Using SASSI screening tools can provide information on ongoing legal problems that can be helpful in treatment planning. Since there are multiple causes of habitual offending, instruments that measure a single factor are not likely to be effective in early identification of high-risk individuals. The SASSI Correctional (COR) Scale identifies individuals with a history of legal problems. While it is unclear why the COR items identify these individuals, there are many possible factors to explore, including: impulse control, anger management, high risk-taking, not responsive to consequences of behavior, low frustration tolerance, and poor social skills.

Effective Screening

Screening is a first step; but a vital and cost-effective first step, particularly in settings that process large numbers of clients. After identifying high-risk individuals, it is important to gather information that is useful in developing a treatment plan.

Client-Appropriate Treatment

There is real value in gathering information that is directly useful in planning therapeutic interventions that will address the client’s specific needs. When screening and assessment are conducted with the intent to help the professional join the client in setting effective treatment goals and planning how to achieve them, the screening and assessment becomes a vital part of the treatment process. It is important to use tools that are accurate and provide clinically useful information.

Despite the overall effectiveness of SUD treatment and despite the demonstrated cost-effectiveness or providing treatment as part of society’s response to criminality, rehabilitative diversionary programs are not maximally effective in reducing rates or recidivism. Part of the solution lies in developing interventions that are sensitive to subgroup differences and individuals’ needs. Individuals with SUD differ from one another. They therefore respond differently to different types of treatment.

Matching treatment on the basis or the nature and degree of the client’s psychopathology and sociopathy increases the effectiveness of the treatment. While it may not be possible to fulfill all the mandates, if we wish to reduce recidivism within the criminal justice system, it is necessary to identify the individuals most at risk, determine their treatment needs, and provide treatment tailored to those needs. The SASSI screening tools can be a very helpful first step in that direction.

The SASSI as a Cost-Effective Screening Tool in Criminal Justice Programs

Working with mandated clients can be challenging. Mandates are in place with goals to reduce crime, decrease recidivism in the criminal judicial system, lower the prison population, and cut back on substance use and addiction.

These are all great goals; however, achieving them can be more difficult than proclaiming them. Professionals in the fields of health care,criminal justice. and other social services are given the charge of executing the mandates and bringing the goals to fruition.

Addiction is a serious and widespread health problem: it has a devastating impact on individuals, their significant others, and society. As a health care problem, substance use disorder (SUD) is tied to issues in criminal justice. One of the common consequences of SUD is legal difficulties.

Money, a central issue underlying all mandates, is certainly a complex issue in SUD treatment. It costs money to treat SUD, but it costs more not to treat individuals suffering from them. With so many cutbacks and rising costs, professionals have been asked to do more with less. We are asked to balance the complex and often contradictory needs of our clients, referral sources, funding agencies, boards of directors, and society.

SUD treatment is intimately tied to the criminal justice system. Many of us work directly within the criminal justice system, and many more of us serve clients who are referred by colleagues from courts and correctional programs. There is an expectation that our services will address the mandates. We are expected to rehabilitate individuals, cut back on drug abuse, reduce crime, lower jail populations, and be cost-effective. We are expected to do more, do it better, and do it all with fewer resources. One way to cut back costs is by conducting early interventions. The SASSI screening tools help address the challenge of early intervention by providing a means of identifying and addressing risk. A first step in reducing recidivism in the criminal justice system is to screen legal offenders to identify individuals who are at greatest risk for ongoing legal difficulties and who are likely to have an SUD to provide them with appropriate and timely treatment.

A Common Element in Domestic Violence: Substance Misuse

The following profile is for a 38-year-old male, “Blair,” who has been mandated to counseling following an instance of spousal abuse. First, note that the scale scores do not meet the criteria for classifying Blair as High Probability of having a substance use disorder (SUD).  However, the Face-Valid Alcohol (FVA-12) and Face-Valid Other Drugs (FVOD-13) scores are moderately elevated above the mean (50th percentile) since they are more than one standard deviation from the mean and above the 85th percentile. It is important to recognize that FVA and FVOD are not just measures of frequency and quantity of consumption. Rather, they are mostly measures indicating acknowledgement of significant negative consequences as a result of substance misuse, as well as possible loss of control and using as a coping mechanism. Thus, even moderately elevated scores that do not in and of themselves lead to classifying the person as high probability of having a SUD are often indicative of some level of substance misuse. It is important to investigate this further. We not only want to establish whether substance misuse is a current or past pattern of use, but (in the context of this client’s reason for referral) further investigation is also needed to determine more about the relationship between physical abuse and substance misuse in this client’s life.

Note that the Obvious Attributes (OAT-1) score is low, i.e. it is below T40 where less than 15% of the normative sample typically scores. This type of OAT score suggests that Blair does not acknowledge the typical negative attributes or behaviors commonly associated with substance misusers such as impulse control problems, low frustration tolerance, impatience, a tendency to hold grudges, etc. An OAT score this low suggests it is not simply that he does not perceive himself as engaging in such behaviors, but that he actively (consciously or unconsciously) distances himself from any hint that he has such tendencies. In other words, he finds it difficult to acknowledge common weaknesses, personal limitations or human foibles and certainly does not see himself as being in any way similar to those who have substance problems. Often, people who come from homes that were dominated by abuse, substance misuse, or other problems are motivated to see themselves as not being like the primary abuser in their family of origin. His very elevated FAM score (FAM-14) and to some extent his somewhat elevated SYM (SYM-5) score suggest that he may have lived in an environment affected by substance misuse.

The Subtle Attributes (SAT-2) score is also significantly below average, and this can often indicate a person who may exhibit strong feelings of hypersensitivity to what others think of him stemming from his perception that others frequently reject him and unfairly judge and criticize him. This score suggests that Blair may be highly attuned to others’ opinions and may perceive slights or criticism, even when none are intended. 

The Defensiveness score (DEF-11) is very significantly elevated. This often indicates someone who has their guard up and answers the questions by endorsing only things that may make them look more positive. This is not particularly abnormal in cases like Blair’s where there are situational factors putting him at risk of losing something important to him. Since Blair is being evaluated following an accusation that he beat his spouse, he is naturally on guard. The defensiveness could also reflect a more general tendency to avoid seeing and acknowledging any personal limitations or weaknesses and is somewhat confirmed by his very low OAT score as discussed earlier. Regardless of the cause, it is important to recognize that Blair probably approached the screening process in a defensive manner and because of this there is also a higher-than-normal possibility of a false negative and potentially a possibility that Blair minimized some of his symptoms of misuse on the more face valid scales such as the FVA, FVOD and SYM.

As mentioned earlier, Blair’s score on the Family vs. Controls (FAM-14) scale is significantly elevated. The FAM scale is composed of items that tend to identify individuals who may have been involved in a family of origin in which there was significant substance misuse. People who have high FAM scores often may obsessively focus on the needs and feelings of others. It is therefore interesting to contemplate how a high FAM score might fit as a characteristic of a perpetrator of domestic violence since spousal abusers are not generally thought of as “caretakers.” The crucial element may be the tendency of individuals who score high on the FAM scale to base their happiness and their sense of well-being on the behavior of others, leading to a need to control. Violence can be an extreme expression of a profound need to control.

Based on his SASSI scores, the Decision Rules result indicates a low probability of Blair being diagnosed as having a SUD. However, the significantly elevated DEF score cautions that there is an increased possibility of a false negative result (i.e. test-miss). His FVA and FVOD scores, while not high enough by themselves to provide a “high probability of a SUD” result, were clear indicators of acknowledged negative consequences from misuse of substances. Given the fact that many people with DEF scores as high as Blair’s often minimize some or a lot on the face valid scales to make themselves look better, there is still a possibility that Blair may suffer from a substance use disorder. Substance misuse is a common ingredient in domestic violence.

Domestic abusers often do not assume responsibility for their behavior, claiming that the victim “made me do it.” Blair’s SASSI profile corroborates and expands on this. The low SAT score suggests that Blair may have this victim mentality, and the low OAT score suggests that he is indisposed to see in himself the very tendencies that are likely to lead to spousal abuse such as low frustration tolerance, poor impulse control, anger management problems, a tendency to hold grudges, etc. The high-DEF score suggests a broader proclivity not to acknowledge personal limitations and to only endorse positives; and an extreme focus on others, as suggested by the high FAM score, could lead to an inability to deal effectively with interpersonal conflict. Ongoing comprehensive assessment should be directed toward determining more precisely the role of substance misuse in Blair’s spousal abuse. Treatment should also be directed toward helping Blair perceive and act in accord with appropriate personal boundaries. He is likely to need help in learning to accept and deal with interpersonal conflict and to assume greater responsibility for his behavior. As it stands, his extreme need to control others may lead to poor social judgment that allows him to construe violent acts as mature behavior and provides him with a rationale for excusing the inexcusable.

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, 1 pm to 5 pm (EST).

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SASSI Instruments

The SASSI Institute offers the following brief and easily administered psychological questionnaires:

SASSI-4 | Adult Substance Abuse Subtle Screening Inventory-4

Identifies high or low probability of substance use disorders in adults 18 and older and includes a prescription drug scale that identifies individuals likely to be abusing prescription medications. It also provides a measure of profile validity and clinical insight into level of defensiveness and willingness to acknowledge experienced consequences of substance use disorder.

SASSI-A3 | Adolescent Substance Abuse Subtle Screening Inventory-A3

Identifies high or low probability of substance use disorders in adolescent clients ages 13-18. It also provides clinical insight into family and social risk factors, level of defensive responding, consequences of substance misuse teens endorsed, and a prescription drug abuse scale that identifies teens likely to be abusing prescription medication.

Spanish SASSI | Spanish Substance Abuse Subtle Screening Inventory

A Spanish language screening instrument empirically validated in clinical settings for use with Spanish-speaking adults from diverse ethnic backgrounds.

BADDS| Behaviors & Attitudes Drinking & Driving Scale

Identifies preintervention risk of future impaired driving, and changes in DUI-related risky behaviors & attitudes following intervention. Ideal for initial risk assessment, pre and posttest screening, and program evaluation.

We invite you to reach out to us for additional information and with any questions you may have at 800.726.0526. Training is available on all instruments.

Youths As Role Models

We previously had a wonderful team member, Marlene K. Brooks (1940-2016), who began work at the Institute in 1993 before retiring to Florida in 2005. During that time, she assisted in the development of the Adolescent SASSI-A2 as Executive Assistant and Editor. When the 2nd iteration was released, Marlene gave a thank you to all the professionals who are involved with helping youth make positive choices and she shared the following personal story which demonstrates how teens can be role models for other teens and adults alike. We thought those of you who missed it would find value in being reminded that you do make a difference in the lives of youths through education, prevention, and early intervention.

My Granddaughter, My Role Model

My oldest grandchild, Kara, entered the 9th grade this year, her first year of high school. Kara is beautiful – inside and out – a wholesome, healthy 14-year-old, who doesn’t try to look or act older than her years. An honor student, she takes her schoolwork and other responsibilities seriously. She is praised by her teachers and has always been a source of pride to our family.

But Kara has always been something of a “home-body,” and by choice, has sheltered herself somewhat from the “real world.” Therefore, I was concerned for her this year, fearful that she may be a bit naïve and have difficulty when confronted with the types of issues that surely would arise in a large South Florida high school. None of us realized the strength of character this seemingly shy young girl possessed.

During the summer, Kara was invited to a slumber party given by a friend she liked and so accepted that particular invitation. Not long after she arrived at the party, she called her parents to come and pick her up. They didn’t question why but immediately drove over to get her. On the way home, she explained that two girls had come to the party and were smoking pot, and she promptly announced that she was leaving. She told her mom and dad that she knew everyone was going to be mad at her, but she didn’t care. The next day the girl hosting the party called and told Kara that after she had gone home, the others asked the two girls to leave. We all told her how proud we were of her for setting such a wonderful example, but that wasn’t the end. She called me one evening, and of course I asked how school was going. She said she loved it, had made all A’s and one B, and was excited to be going to her first football game the next night. And then she said, “Guess who I ran into that just started going to our school – one of the girls who was smoking pot at the party. She looked different – “nicer” – and she came up to me and told me that she wasn’t doing the things she used to do anymore, and that it was because of me! And Kara kiddingly said to her “Do you mean I’m your role model?!”

I searched what’s left of my memory, trying to think of a time when I was as courageous and outspoken among my peers about “doing the right thing” as Kara had been. I think that we as adults have become so preoccupied with being “politically correct” that we hesitate to reveal our own convictions – not that we should ever offend, but we should be able to take a stand against those behaviors that we believe in our hearts to be wrong or harmful. Kara took a stand, despite feeling that she may become “unpopular.” As it turned out, she earned not only the respect of her elders but that of her peers. Her classmates now call her “the Prude” and nominated her for Prom Queen.

What better role model could a grandmother have!

Originally published in the SASSI News & Reports Volume 9, Number 2, Dec. 2001, print edition.

Help Us Shape the Future of SASSI Online

At The SASSI Institute, our mission has always been to provide you with tools that make your work easier, more accurate, and more effective. SASSI Online has grown into an important resource for clinicians, educators, and professionals in the field of substance use screening — and that growth is thanks to the support and feedback of our valued customers.

Now, we’d like to hear directly from you.

What features would make SASSI Online even more useful in your daily work?

  • Are there tools or functions that could save you time?
  • Are there any enhancements to reporting, data management, or integrations that would make your workflow smoother?
  • Is there something you’ve always wished SASSI Online could do?

No suggestion is too small or too big. Whether it’s a streamlined way to organize client assessments, a new type of dashboard, or a feature you’ve seen in other platforms that you’d love to have here—we want to know.

Your input will help guide our development team as we continue to improve SASSI Online and ensure it remains a tool that truly supports your practice.

👉 Please share your ideas with us by clicking here.

Thank you for being part of the SASSI community and for helping us shape the future of SASSI Online!

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.

Live SASSI Training Online and Clinical Q&A Webinar Coming Up – Register Now!

We will be hosting a Live online SASSI Training webinar on the Administration & Scoring of the web-based format of the SASSI (SASSI Online) as well as Clinical Interpretation in September. These sessions are $60 USD each and provide 3.5 CEUs. You can learn more and register by clicking here.

We also invite you to join us for a free one-hour SASSI Clinical Q&A webinar hosted by our Clinical Director, David Helton, LMSW, LCDC. The Q&A is for anyone new to using the SASSI, those considering using the SASSI, or seasoned veterans at screening with the SASSI. The Q&A is scheduled from 11 am – Noon ET on: October 28th. 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 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.

Lowering Defensiveness in Clients

In our last blog we discussed a profile with defensive responding on the SASSI. In this blog, we would like to discuss strategies for handling clients who respond in this manner and the steps that might be taken to reduce defensiveness prior to administration of the SASSI.

The two factors most frequently related to defensive responding are 1) the purpose of the evaluation – i.e. to determine if there is a high probability of a substance use disorder and 2) the context or setting in which the evaluation is taking place – i.e. situational factors that may result in serious consequences for the individual such as jail time, loss of a job or loss of child custody. While there may be little that can be done to change the reason for a SASSI screening, there are a few things you can do to reduce the effect of the stigma and fear that many individuals feel in legal, EAP, or child welfare settings. Research suggests that professionals working with a client in any setting are more likely to have positive successful results with that person if they are able to develop a positive rapport with them. Specifically, you can help the client view your role as one of a helping professional who values them as an individual, recognizes and is empathetic to the difficulty they are currently facing and desires not to punish or demean them, but to assist in getting them any help they may need.

Building rapport with a client before presenting the SASSI to them can be as simple as meeting them in the lobby, smiling at them genuinely, asking about their well-being, and spending some time talking to them in a manner that you would use with anyone you were interested in getting to know better, rather than immediately “getting to the business” of the trouble that brought them there. Talking to the client in this friendly, engaging and empathetic way can be useful in helping the client to develop a higher level of trust in you, to lower their defensiveness, and to be more forthright and honest in their answers on the SASSI questionnaire. Using this procedure gives you a chance to put the client at ease and reduce any perceived threat by beginning to develop a trusting and empathic relationship. Letting clients know that you understand their pain and acknowledging how scary it must be to go through this process will also help to reduce the fear and apprehension that often leads to defensive responding.

Additionally, clinical experience has shown that clients tend to respond less defensively when told in advance that they will have a chance to talk over their answers to the questionnaire with you after they’ve finished. Letting the client know upfront that you will discuss their responses with them after they finish gives clients the message that you view them as important and value their input and perspective. One very common fear among mandated clients is that they will be mistakenly or unfairly judged by a system that doesn’t care much about their well-being. If clients know that you are someone who will not jump to conclusions and are willing to listen to their point of view, they will usually have less of a reason to feel threatened. Letting them know that the questionnaire is simply a way for you to get to know them better and to find out what problems, if any, you can help them with, as well as telling them that there are no right or wrong answers increases the likelihood that they will respond in a more open and forthright manner. It is also often useful to refer to the SASSI in terms that are not perceived as negative such as “questionnaire” rather than “test”; “survey” rather than “screening instrument.” Taking these steps will help to ensure that clients will be more open to hearing your feedback and comments when it is time to review the SASSI results.

In short, the two most effective ways to reduce the likelihood of defensive responding on the SASSI are to 1) spend some time building a positive trusting rapport with the client before ever introducing the SASSI or talking about why the client is seeing you, and 2) administer the SASSI in the context of an empathic and trusting relationship and let the clients know that they will have a chance to review the results with you.

If you would like to discuss any of your clients screening results, feel free to call the free clinical helpline at 800-726-0526, option 2.

Young Parent in Custody Evaluation: Low Probability with High DEF

The profile being discussed is for Julia, a 21-year-old single parent female, who is participating in mandated counseling following an allegation that she has been neglecting her child. The child was removed from her care and placed with family members temporarily. This counseling will play a major role in her being allowed to resume custody of her child.

There is probably no circumstance more likely to evoke feelings of defensiveness in a person than revealing the details of personal, family life, and private attitudes for others to scrutinize, particularly when other people are given the power to determine an individual’s parenting abilities and possibly remove one’s child from custody. It is no surprise then that Julia’s DEF score is elevated, given the difficult situation she is in. In reviewing Julia’s SASSI scores, she does not meet the criteria for classification as High Probability of having a substance use disorder (SUD). While elevated DEF scores, when coupled with a Low Probability result, can potentially imply an increased possibility of the SASSI missing an individual with an SUD (a false negative), an elevated DEF may also reflect serious and difficult situational factors facing Julia with custody of her child at risk.

The most striking and important feature of her profile is that most of her individual scale scores are rather “flat”, not really deviating very far from the mean (T Score of 50), which is where most average people would score. Besides the DEF scale score, only the COR score is significantly elevated. This suggests that overall she responded in a generally “average” way (answering similarly to people not in treatment for SUD). The two exceptions are DEF and COR.

Her high DEF score indicates a possible tendency to endorse only things that make her look good to others, to have her guard up so as to not reveal anything about herself that may be viewed as negative. Again, when one is being accused of child neglect and one’s child could be removed from the parent, it is quite normal for that parent to have their defenses, their guard way up and not want to show any weakness or negative traits, even though all humans have weaknesses with which they struggle. Therefore, this high level of defensiveness could be seen as entirely situational or perhaps even a personality trait. In addition, it is noted that while Julia’s DEF scale score is very high, her SAM scale score is not at all high. Prior case studies reveal to us that often when a person has a high DEF scale score and also has a high SAM score, this could be an indicator that the person’s defensiveness may be related to substance abuse. That is not the case here though. It is therefore most likely that her defensiveness is more general and situational rather than being specifically related to substance misuse.

Julia also had a very high score on the COR scale. While this score has nothing to do with the SASSI decision rules leading to a result of high or low probability of a substance use disorder, our experience with high COR scores indicates that a person with high COR scores is answering the questions on that scale very similarly to the way a person with a long history of criminal justice involvement would answer. Therefore, a person with a high COR scale score could be at greater risk of engaging in behavior that may get them arrested. Sometimes certain personality traits of the individual can be found in clients with high COR scores that may contribute to their risk of acting out and being arrested. Therefore, it is often recommended that the therapist explore for signs of low frustration tolerance, anger management problems, poor social skills, poor impulse control or being one who enjoys engaging in high risk behaviors and add these to the treatment plan to try to lower risk.

In summary: While Julia is alleged to have engaged in child neglect, there can be many reasons why a parent may engage in this behavior, with substance abuse being only one of them. As the SASSI is not designed to be a measure of a wide variety of pathologies, but is limited to the role of determining the likelihood of a substance use disorder, the results indicate that substance use disorder is not likely.

It is important to acknowledge the reality of the fear and pain underlying defensive responding on the SASSI. In order to do so, it is valuable to have a good understanding of the nature of your client’s defensiveness. There is no clear evidence in this case that defensiveness is an ongoing characterological feature or personality characteristic of Julia. Her defensiveness therefore is likely to stem from situational factors. Having said that, her high COR score indicates potential risk of engaging in behaviors that could cause her to get in trouble which may be fueled by difficulty controlling her anger and frustration and may cause her therefore to display poor judgement and act impulsively. These potential issues could indeed put her child at risk as well as herself and so should be explored carefully.

Be sure to read our next blog which will discuss tips for reducing defensiveness.

As always, feel free to call our free clinical helpline M-F 1-5 pm ET for assistance in administering, scoring, and/or interpretation of profile results at 800-726-0526 Option 1.