Tag: The SASSI Institute

LGBTQA issues: What side of the Profile Sheet to use in cases where gender is in question?

We receive regular phone inquiries regarding which side of the Profile Sheet to use in scoring either the Adolescent or Adult SASSI when the client identifies as transgender or neither male nor female. This comes up whether one is using the paper and pencil or the online version.

To affirm one’s self-identity can be powerful and empowering so a discussion with a client who is either questioning their gender identification or sexual orientation or is very clear about either one can be a very supportive encounter. The message given is one of sensitivity, respect, and validation for their choices.

As a way of addressing this issue the adult SASSI-4, adolescent SASSI-A3, and Spanish SASSI ask for ‘gender’ in the demographics rather than ‘sex.’ This allows the client to indicate their self-identity. What side of the profile sheet used for scoring purposes should either (1) conform most closely to what the client indicates or (2) after discussion with the client, what they feel most comfortable with given the gender limitations of M/F on the SASSI.  The research is based on binary identification and as such, we are limited in adding additional categories. Future research will undoubtedly be more inclusive. Regardless, the results are valid. The overall goal of the inventory is to give both the administrator and the client a compass to follow with useful information regarding the extent that substance use may or may not be a problem.

To be clear, score the side of the profile sheet that the transgender client self-identifies with. Not when or if they started hormones, or in a current state of transitioning, or they identified as a different gender when the legal offense happened.

A client may express a preference to not identify in any way and decline any gender identification. In that case, the administrator may want to score both sides of the SASSI to see if there is any difference in the result. More often than not, the result will be the same. The primary differences in M/F are in the FVA/FVOD scales which impact Rule 1 and Rule 10 in SASSI-4. There are no differences in the SASSI-A3.

The following is a list of LGBTQA terminology and definitions provided from the Prism Youth Community, part of Bloomington PRIDE here in Indiana:

These definitions were borrowed and adapted from several sources including the University of California- LA LGBT Campus Resource Center, the University of California Berkeley Gender Equity Resource Center, the University of Michigan Spectrum Center, and the University of Wisconsin Milwaukee LGBT Resource Center.

Definitions may vary with location, era, and culture. It is very important to respect people’s desired self-identifications. One should never assume another person’s identity based on that person’s appearance. It is always best to ask people how they identify, including what pronouns they prefer and to respect their wishes.

Ally – Typically any non-LGBT person who supports and stands up for the rights of LGBT people, though LGBT people can be allies, such as a lesbian who is an ally to a transgender person.

Androgyne – A person appearing and/or identifying as neither man nor woman, presenting a gender either mixed or neutral.

Asexual – A person who is not sexually attracted to any gender or does not have a sexual orientation. Asexuality is not the same as celibacy.

Bisexual or Bi – A person emotionally, physically, and/or sexually attracted to males/men and females/women. This attraction does not have to be equally split between genders and there may be a preference for one gender over others.

Cisgender – A person who feels comfortable with the gender identify and gender expression expectations assigned to them based on their physical sex.

Gender Expression – The way in which a person expresses their gender identity through clothing, behavior, posture, mannerisms, speech patterns, activities, and more.

Gender Identity – A person’s sense of being masculine, feminine, or other gendered.

Genderqueer A gender variant person whose gender identity is neither male nor female, is between or beyond genders, or is some combination of genders.

Homosexual or Gay – A person primarily emotionally, physically, and/or sexually attracted to members of the same sex.

Intersex – A person whose sexual anatomy or chromosomes do not fit with the traditional markers of “female” and “male”. For example: people born with both “female” and “male” anatomy (penis, testicles, vagina, uterus); people born with XXY.

Lesbian – A female-identified person attracted emotionally, physically, and /or sexually to other female-identified people.

LGBTIQA+  – Lesbian, gay, bisexual, transgender, intersex, queer, asexual or ally, and other identities.

Pansexual – A person who is sexually attracted to all or many gender expressions.

Partner – A significant other in an intimate relationship; a gender-neutral alternative to boyfriend/girlfriend, husband/wife, or other binary-based relationships terms.

Queer – 1. An umbrella term for people who are not heterosexual or cisgender. 2. A reclaimed word that was formerly used solely as a slur but that has been semantically overturned by some members of the LGBTIQA+ community, who use it as a term of defiant pride.

Sex – A medical term designating a certain combination of gonads, chromosomes, external gender organs, secondary sex characteristics and hormonal balances.

Sexual Orientation – The desire for intimate emotional and/or sexual relationships with people of the same gender/sex, another gender/sex, or multiple genders/sexes.

Sexuality – A person’s exploration of sexual acts, sexual orientation, sexual pleasure, and desire.

Trans – An abbreviation that is sometimes used to refer to a gender variant person. This use allows a person to state a gender variant identity without having to disclose hormonal or surgical status/intentions.

This term is sometimes used to refer to the gender variant community as a whole.

Transgender – An umbrella term for a person whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth.

Recent Article Investigating Denial Among Mandated Adolescents

The SASSI Institute is proud to announce our newest manuscript addressing adolescent substance
abuse. The title of this article is Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial. It provides an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers. Part of the data set we collected for The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3, the present study focused on data from 164 mandated teens that participated in the principal study. As in the principal study, these cases were drawn from substance use treatment, criminal justice programs, community corrections, and private clinical practices, among other venues, and all cases were provided by clinicians working within these service settings throughout all U.S. Census Regions.

In addition, we review cases demonstrating high-levels of defensiveness and denial in these mandated teen clients, and ethical ways to break through that barrier towards effective treatment engagement. Finally, we present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. We at The SASSI Institute are very proud of this work, and I want to personally thank my co-authors for making this work possible. The article is available free of charge as it was submitted as an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows readers to copy, redistribute, remix, transform, and reproduce in any medium or format, as long as the original authors are properly cited. You can read this article, as well as other articles related to the SASSI, on our References page.

This article also apears in the Indiana Criminal Justice Association’s, The Comment, Spring Edition.

SASSI Online Tips and Tricks: Volume 2 | Delivery Options

In this edition of SASSI Online Tips and Tricks we highlight setting up a questionnaire and the delivery options. When administering a questionnaire, you have six options. This volume will cover the first five in depth. The last one, SASSI to Go, will get its own volume, so watch for that!

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“Fentapills,” Fentanyl, illicit opioids & the Black-Market Internet: A Perfect Storm of Danger and Death

The underlying headline is that we, as a group, must unify our efforts on all fronts to protect all of these individuals, which unfortunately include friends, family, and loved ones. Substance Use Disorder indeed does not discriminate! Let’s up our awareness, prevention efforts, and of course interdiction.

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Creation of the SASSI & Fine-tuning of the SASSI

To understand the SASSI, you need to understand how the subtle items were selected.  Dr. Glenn A. Miller considered several thousand potential items. First, he excluded items that reflected either general maladjustment or, conversely, obvious social desirability. He gave questionnaires containing potential items to both individuals in treatment for substance use and to control subjects. Then he looked for items that the members of one group usually answered differently from the members of the other. Although no single question could identify every person who had a substance use disorder, statistical analyses detected a set of questions that people with substance use disorders consistently answer differently than other people.

The only reason any question was included was that it worked to identify substance use disorders, not that it seemed to be related to substance misuse.

Dr. Miller did not base the SASSI upon a theory of substance use disorders, but rather used statistical analyses to empirically select those items that distinguished between known criterion groups of individuals with and without the disorder. For the purposes of screening, we do not need to understand why people with substance use disorders are more likely than other people to answer True to “I have been tempted to leave home.” What matters is that responses to this question can help us identify people who are likely to need further evaluation for a substance use problem. Research has shown that people who answer the questions similarly to people with substance use disorders have a relatively high probability of having a substance use disorder.

To further deal with the resistance that so often characterizes substance use disorders, individuals with known substance use disorders were asked to answer the questionnaire as if they were applying for an important group membership and were directed to try to hide signs of their shortcomings and problems, particularly those related to the misuse of alcohol and drugs. Analyses of answers given under these “fake good” instructions identified two types of items — those items that distinguished people who had substance use disorders from people without such disorders even when people were instructed to conceal problems, as well as items that helped identify defensive responding.

Statistical analyses revealed that the SASSI could most accurately and usefully identify individuals with substance use disorders if the items were compiled into scales, and decision rules were created for analyzing the scores.

Items were tested with various groups and selected to minimize the effects of gender, age, socio-economic status, ethnicity, and drug of choice.

Extracted from:

Lazowski, L. E., Kimmell, K.S., & Baker, S.L. (2016). The Adult Substance Abuse Subtle Screening Inventory-4 (SASSI-4) User Guide & Manual. Springville, IN: The SASSI Institute.

SASSI Online Tips and Tricks: Volume 1 | Support Materials

In this edition of SASSI Online Tips and Tricks we highlight the documents located under the Support Materials page.  Access the Support Materials through the Account Dashboard’s, My Clients tab. The Support Materials button is to the right of the Administer button. There are four quadrants on the Support Materials page, the top left is for Adult SASSI-4 documents, the top right contains the Adolescent SASSI-A3 materials, and the bottom left is for the Spanish SASSI. The bottom right section provides general information.

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Recent Article Investigating Denial Among Adolescents

The SASSI Institute is proud to announce our newest manuscript addressing adolescent substance abuse. The title of this article is Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial. It provides an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers. Part of the data set we collected for The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3, the present study focused on data from 164 mandated teens that participated in the principal study. As in the principal study, these cases were drawn from substance use treatment, criminal justice programs, community corrections, and private clinical practices, among other venues, and all cases were provided by clinicians working within these service settings throughout all U.S. Census Regions. In addition, we review cases demonstrating high-levels of defensiveness and denial in these mandated teen clients, and ethical ways to break through that barrier towards effective treatment engagement. Finally, we present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. We at The SASSI Institute are very proud of this work, and I want to personally thank my co-authors for making this work possible. The article is available free of charge as it was submitted as an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows readers to copy, redistribute, remix, transform, and reproduce in any medium or format, as long as the original authors are properly cited.

We Would Like Your Feedback!

We want to take this opportunity to inform you of a small questionnaire we are deploying in the coming weeks. We’d really appreciate your feedback and we’d like as many of you as possible to take the time to fill out this brief anonymous form. We feel that if we receive enough responses, it will provide us with critical information on how we might better serve your needs when treating your clients. We consider you our collaborators our ‘feet on the ground’ in this ongoing war against substance use disorder. We will provide links to the survey in various ways and consider you input invaluable.

If you would like to fill out the survey now, here is the link to complete.

Thank you for your consideration.

Psychopharmacology and the Biology of Addiction Webinar

Increase your understanding of how drugs of abuse interact with each other as well as what takes place in the brains of experimenters, abusers and addicts. Improve your ability to communicate with medical professionals and your clients.

On March 29th and 31st, 2022, Dr. Donald R. Osborne, Jr., author of the newly released book “You Can’t Fall Out of a Hole: Ripping the Band Aid off of Our Addiction Epidemic,” will be hosting a live webinar to increase your knowledge on the subject of Psychopharmacology and the Biology of Addiction.

Information that will be presented and discussion will be about the following:

Central Nervous SystemPeripheral Nervous System
Autonomic Nervous SystemSomatic Nervous System
Sympathetic Nervous SystemParasympathetic Nervous System
How the Brain WorksTolerance and Cross-Tolerance
Rebound / WithdrawalDrug Half Life / five to eliminate
THIQ in Alcohol MetabolismDopamine Depletion by Cocaine
Determining BAC by number of drinks consumed

The following drugs/drug classes will be examined:

OpioidsAlcohol
Sedative-HypnoticsCannabis Sativa
CocaineSympathomimetics
InhalantsHallucinogens
Club DrugsCaffeine
Nicotine

For each of the drugs/drug classes, the following information will be provided and discussed

  • Examples
  • Route of Administration
  • Absorption
  • Distribution
  • Effects
  • Metabolic Half-Life
  • Elimination
  • Rebound/Withdrawal

The webinar will be live from on March 29th, 9:30-1pm ET, and March 31st, 1:30-5pm ET. The webinar will be available on-demand afterwards.

To register, click the date you are interested in below:

Reviewing an Adolescent SASSI-A3: Vaping Issue

This is an issue that may be turning up in your clinical practice. The caller wanted help with a profile interpretation on a 13-year-old male who had turned in a vaping pen. The school was mandated to do a substance use evaluation as a result. The online report indicated “inconsistencies” in the results so the counselor wanted more information. The client was instructed to complete the FVA/FVOD side for his whole lifetime.

The overall result, based on all the rules being ‘no’, came up with a Low Probability of a substance use disorder. The Prescription Drug Scale was zero. However, the Validity Check Scale was 6 so further evaluation was recommended. Elevated VAL and DEF scores coupled with a Low Probability result increases the possibility of the SASSI missing individuals with a substance use disorder.

Looking at the graph on the profile sheet helps to pull out additional information. Note the very low (below the 15th percentile) OAT and SAT scores. The low OAT can indicate someone who has a hard time acknowledging personal limitations or shortcomings. The low SAT can indicate someone who has a chip on their shoulder, feelings of rejection and hypersensitivity to others. Interestingly, the DEF score is within the norm and does not indicate the student was defensive completing the SASSI. The FRISK score is above average but within the norm and because it is a Face-valid scale, content analysis of those items may be useful. The other Face-valid scales, ATT and SYM with their scores of 1 can also be examined.

The student who turned in the vaping pen indicated it was not his. It was not clear from the caller what substances they suspected were being used. Clinically, the best thing to keep in mind is that the student has a hard time opening up and is probably very concerned about how he is viewed by teachers, counselors, etc. and very quick to feel rejected. Interacting with him in an accepting and affirming way is probably the best approach.

Substance use issues: The VAL of 6 is a red flag so further evaluation with this student is warranted. It could be on-going oversight within the school, i.e. school counselor or referral to a Substance Use counselor who could do a more formal and comprehensive assessment.

We hope this is useful for you.

As usual, don’t hesitate to call the Clinical Helpline at 800-726-0626 with any clinical questions. Live clinicians are available M-F, 11-5 pm (EST). Otherwise, feel free to leave a message and we will get back to you the next business day.

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