Tag: SYM Scale

Symptoms
discriminated between people diagnosed with and without substance use
disorders based on their endorsements of symptoms and consequences
of substance misuse

Showing Respect for the Realities of Peoples’ Worlds

In a past blog we shared an interpretation titled “SYM Scale and Environmental Factors” which discussed SASSI-4 profile scores for a Native American couple residing in Canada. 

The profiles in that blog highlight a challenge that professionals face as they seek to help people overcome problems associated with substance misuse. You likely often work with individuals who consume large amounts of psychoactive substances and experience negative consequences but genuinely do not perceive that they have a substance use problem. Helping people gain awareness of such problems is a daily task for professionals. The blog demonstrates the importance of being sensitive to and respecting individuals’ realities as you endeavor to help them grow.

One reason why people may have difficulty perceiving that their substance use has a negative impact on their lives is that the substance brings immediate relief from emotional pain, even though greater pain is the ultimate consequence. Many clients face the not so easy challenge of having to recognize that their ongoing problems are attributable to an important and apparently satisfying behavior. As people confront the need to stop their misuse of psychoactive substances, they must let go of what may be a primary and valued aspect in their lives. What is recognized as a major source of their problems, they may see as the only solution. To help individuals who suffer from substance misuse, it is necessary to understand and respect the way they perceive their usage.

Some people do not recognize the impact that substance misuse has on their lives because they do not see an alternative. This phenomenon is not limited to small, geographically isolated communities like Mary and John’s (see SYM Scale and Environmental Factors). Many people who live in larger towns are members of sub-communities in which substance misuse is the norm, “everybody drinks and drugs, everybody has family fights, everybody has hangovers, everybody has money problems, everybody has legal problems.” As a service provider, there is a responsibility to recognize and deal effectively with the realities that confront individuals. It is disrespectful to expect people to easily reject a central aspect of their social milieu and readily embrace a lifestyle that is completely foreign to them.

Providing clients with feedback on the SASSI can promote a collaborative relationship in which you can join the client in the process of exploring their world and seeking ways in which to enhance the quality of their lives. Consider Mary & John’s profiles; an outstanding scale are the elevated SYM scores. SYM provides a measure of clients’ acknowledgment of being involved in a pattern of heavy usage and associated negative consequences. Since it is composed of items that directly address substance misuse, it is valuable to review the endorsed items with clients and ask them for elaboration. For example, an elevated SYM score may indicate a history of parental substance misuse, early onset of substance misuse, and associated family problems. During the process of providing feedback, it is important to promote discussion to help clients gain a greater understanding of the role of substance use in their lives and to help them increase perspective and insight into the way substance use has affected their lives.

Professionals expect clients to be receptive to the process of change; so too professionals must endeavor to understand the world in which they live. The act of change is an act of courage. As an addiction professional you are privileged to stand witness to courage shown by clients as they open themselves to new ways of seeing and being in the world. Through patience and understanding, you can hopefully be a source of encouragement and support along the way. 

(Please note that The SASSI Institute recommends examining specific items on the FVA, FVOD, SYM, Rx and on the RAP scale, but NOT on the other (subtle) scales – OAT, SAT. DEF, SAM, FAM, and COR)

Please be sure to utilize our free clinical consultation line for assistance interpreting SASSI profiles M-F 1-5 pm EST at 800.726.0526 Option 2.

Adolescent FRISK, ATT, & SYM Scale FAQ

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.

SYM Scale FAQ

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.

SAM Contributes to SASSI-4 Accuracy

This SASSI-4 profile of a 37-year-old female was called in to our clinical support line. As we look at her results, it appears that she answered the items in a meaningful manner (RAP=0).  She is likely to have a high probability of a substance use disorder (SYM=6, SAM=8) based on decision rule 6.

Notice that despite the relatively low DEF score and apparent lack of defensive responding, the SAM scale score, when combined with the elevated SYM score, leads to a test positive result. While it is true that the SAM scale score plays a vital role in the accuracy of the decision rules in this case, it is important to remember that the clinical meaning of this score is unclear. Therefore, it would be inappropriate to draw any clinical inference from the fact that the SAM score is elevated.

The client acknowledges significant problems related to her use of drugs other than alcohol. She is likely to have experienced some loss of control, negative consequences, and increased tolerance as a result of her substance misuse. However, her average OAT score (OAT=3) may be an indication of some limited ability or willingness to acknowledge behavioral problems commonly associated with individuals who have substance use disorders.

The moderately elevated SYM (SYM=6) is consistent with clients who often are not able to recognize the manner in which substance use is manifested in their lives. Her responses are similar to individuals who live in a social milieu where substance abuse and its related consequences are fairly routine and normalized. This experience may limit her ability to characterize her substance usage as problematic. Indeed, she may be somewhat surprised that the SASSI results could even indicate an addiction problem.

The client’s responses are similar to those of individuals who are experiencing emotional pain (DEF=3). Individuals who score in this range tend to be overly self-critical, may experience depressive symptoms and sometimes report a history of trauma. She may be quite limited in her ability to recognize personal strengths, focusing more on limitations, failures and feelings of low self-worth.

This client is likely to have a high probability of a substance use disorder and should be considered for relatively intensive addictions treatment. A comprehensive behavioral health evaluation may be necessary to rule out the need for additional psychiatric intervention. Although she demonstrates some ability to acknowledge relevant behavioral symptoms of her addiction, a viable treatment plan should include initial efforts to increase her self-awareness and insight into the full nature of her substance use problems. Education and other cognitively based interventions may be helpful.

Most likely, she will need help in recognizing that her misuse of alcohol and other drugs is similar to that of other substance dependent people. A content analysis of her responses on the FVOD and SYM items may be one way to help her realize that it is in her best interest and within her capacity to change.

Community-based self-help support groups could provide additional encouragement and support.

In addition, evaluation for depressive symptoms and its relationship to her substance us would be important to consider.

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