One question we field often on the clinical helpline is what does it mean when either the OAT (Obvious Attributes) is higher than the SAT (Subtle Attributes) or when the SAT is higher than the OAT when both are elevated above the 85th percentile?
Tag: The SASSI Institute
New Workshop: Community Reinforcement Approach for Substance Use in Adults
We hope some of you have been able to participate in at least one of our new Professional Development webinars. We are excited to be able to partner with fellow colleagues in the field of addiction to be able to provide continuing education on professional topics of interest.
We have recently partnered with Courtney Hupp, MSW, LCSW, CADC, an EBT Clinical Coordinator at Chestnut Health Systems in Illinois. She had an active role in the Assertive Continuing Care (ACC) study, funded by NIAAA, in which she administered the ACC and Community Reinforcement Approach (CRA) protocols to residential clients’ post-discharge, as well as supervised other therapists on the study. Courtney will be offering her workshop “Community Reinforcement Approach for Substance Use in Adults” live online through the SASSI Institute’s training platform on February 8th. The treatment model known as CRA recognizes that, at least initially, alcohol and drug use is about reinforcing consequences — that make us more likely to repeat actions. This is true whether we are hanging out with friends, playing a favorite game, eating a good meal, or using alcohol or other drugs. People who use alcohol and drugs get something out of it – or they wouldn’t keep doing it.
The overall goal of CRA is to help individuals reconnect with or discover new sources of positive reinforcement within their community to compete with alcohol or drug use. How do CRA clinicians do this? By listening to and learning from their clients what is important to them. They then help them connect to pro-recovery activities that have meaning and value to their client. In addition, CRA clinicians help their clients identify goals and learn how to achieve them. CRA clients also learn a variety of new skills, such as problem-solving and positive communication (with partners, friends, and others), which help them attain a better quality of life. Practicing new skills is a critical component of the skills training used in CRA. Every session ends with a mutually-agreed upon homework assignment to practice skills learned during sessions. This intervention has been implemented in outpatient, intensive outpatient, and residential treatment settings. This research-tested intervention has been used in over 500 organizations across the United States and Canada. Courtney Hupp will provide an introduction to the CRA model, a summary of the research base, and details about how to use a variety of CRA skills during sessions.
What You Will Learn:
- An Introduction to the CRA model
- History of CRA research and implementation
- Goals of CRA treatment
- An overview of the CRA session structure and treatment guidelines
- How to use some of the CRA procedures during sessions like a Functional Analysis for substance use, Happiness Scale, Sobriety Sampling, and Increasing Prosocial Recreation
- General clinical skills necessary to implement CRA
For registration information click here.
A SASSI-4 Profile Analysis: Prescription Drug Abuse
A caller requested help interpreting the result of a SASSI-4 questionnaire on a male client who presented himself as having an opioid addiction.
‘Curtis’ is a 36-year-old married man. He and his wife have no children. He works as a landscaper which he describes as physically very demanding. His parents smoked marijuana while he was growing up and Curtis also smokes marijuana. His older brother died ten years ago, and Curtis is still grieving. His brother also had substance use issues. Curtis also may have a history of being molested as a child which he does not remember, but his brother relayed that they were both molested by a babysitter.
Curtis reports a four-year history of opioid addiction which started as a result of a herniated disc in his back. He was initially prescribed hydrocodone for pain. He tried to quit once three years ago. Currently, he is ordering “stuff off the internet” or getting oxycontin from friends. He has been taking 180 mg/day with a maximum of 240 mg per day. It takes 150 mg. for him not to get “sick.” Curtis continues to smoke marijuana on the weekends about one time per week. He has a legal history of possession of marijuana in 2004 and attended an outpatient treatment program doing “what I had to do.”
He has been slowly tapering off the opioids for the past five weeks and currently is down to 80 mg/day. His goal is to completely get off the opioids but he is not interested in residential treatment at this time because it is his busiest time of year. Although he has attended NA, he does not like it. Curtis is more drawn to Smart Recovery.
The SASSI-4 was administered for lifetime use on the face valid side of the questionnaire.
What were his SASSI-4 results? Curtis has a ‘High Probability of having a Substance Use Disorder’ and a ‘High Probability of Prescription Drug Abuse.’
This looks like a straightforward profile on the face of it. His score of 42 on the FVOD and 18 on the SYM indicate someone who is very open concerning his drug use, and because these are face valid scales, content analysis could provide useful information to further explore with the client.
The OAT score of 6 is right at the 85th percentile. The client may be able to identify with some of the characteristics of substance users such as impatience, resentment, self-pity and impulsiveness. However, the SAT score of 8 is higher than the OAT and may blunt the ability for Curtis to have insight into his behavior. When the SAT is higher than the OAT, the client may exhibit a lack of awareness or simply denial around the impact drugs are having on his life. In this case and not unusual, opioid users do not see themselves as “typical” addicts. That may account for the OAT score.
The DEF score of 2 can be a ‘red-flag’ as it is below the 15th percentile. A score this low can indicate someone with poor ego strength, feeling helpless and hopeless and may be exhibiting symptoms that look like depression. The clinician may want to do a mental health screening or refer the client for screening.
The FAM score of 5 is also very low, below the 15th percentile. This can indicate the client is focused on himself and not that concerned about others. This does not indicate a personality disorder but given the client’s circumstances, makes sense that he would be more internally focused.
The COR score of 8 is elevated above the 85th percentile. He has answered in a similar way to people who have had legal issues for any reason. We suggest screening for those behaviors or characteristics we often see in that population. These can range from poor social skills, low frustration tolerance, risk-taking behaviors, anger management issues or impulse control issues. These issues could be impacting on Curtis’s choice-making abilities.
Finally, looking at the Prescription Drug Scale. With the score of 14, it is quite clear that he is identifying behaviors associated with prescription drug abuse. Again, as a face valid scale, looking at these individual items will generate a lot of information for the clinician. The clinician will need to look at treatment readiness, discuss medication needs, possible referral and other reported clinical issues.
A Message of Thanks and Giving From the CEO
In this season of Thanksgiving, I felt it appropriate to share some of the many things we at The SASSI Institute are thankful for. This past year has demonstrated our human potential and tenacities in so many ways. Despite the over five million worldwide deaths directly attributable to the COVID virus, our healthcare, teaching and service staff, and yes you, all of the treatment and human service professionals throughout the world have demonstrated that we may have been down, and maybe down again, but we always get back up. There are indeed so many of us that have lost loved ones, friends, or colleagues. Our hearts go out to them. In honor of their suffering and loss, we offer our condolences, our understanding, and our love.
But the proverbial light is there. We can finally see what may be an end to this horrific pandemic. Thanks to the scientific community and healthcare workers throughout the world, we are finally seeing a reduction in case numbers, and hopefully soon, our ability to declare a finality to this dire and deadly disease. If nothing else, it has proven we are all one people, and that our unity truly stands stronger than any divisiveness. Through it all, we have managed to be there for one another, for our friends, colleagues, and our families. We have remained united, and that is and should continue to be foremost in all our minds, and meriting of our thankfulness.
In the meantime, our Board of Directors, senior management staff, and I want to reassure you that despite the multiple supply chain issues, inflationary pressures, and uncertain economic environment, we have once again decided this year to maintain our pricing structure such as it is. We at The SASSI Institute are doing our best to allow you, our licensees, and collaborators to continue to do your jobs, offer the many services you offer, and continue to assist those that need us the most, those still suffering through substance use, co-morbidities and in some cases along with COVID and other health issues, tri-morbidities. This year has also seen many changes in our operational structures and the various features we offer here at The Institute. I am extremely proud of our staff and the non-stop work they have executed this year. Our Training Director has overseen one of our most successful initiatives, The Professional Development Workshops series. In addition to the many trainings we have offered over the years, we now also have nationally recognized experts providing Continuing Education approved training related to substance use disorders, co-occurring disorders, and the incorporation of our SASSI tools in assessment packages for specialized populations. Our customer service, clinical, and IT teams as always, remain at your disposal and are providing non-stop services to facilitate your administration and interpretation of our many tools. I anticipate several other exciting initiatives to come, and we will inform you of them as they develop.
In the meantime, be kind to yourselves, and let’s make it our mission to take care of each other, and most of all let’s remember to be thankful!
In-Person SASSI Training and other Professional Development Courses
Many of our SASSI trainers and other instructors have expressed a desire to get their boots back on the ground and start offering live in-person, hands on workshops again. While we have all been adapting to with what has become a new social norm of online training, webinars, and conference events, many have decided that they are ready to embrace in-person events again.
If you have a group that you would like to discuss arranging a live on-site SASSI Training for, please let us know. You can reach us at training@sassi.com and we can have the trainer/s in your area reach out to you for planning. You can also find a list of available trainers and their contact information at https://sassi.com/sassi-training-us/ and https://sassi.com/sassi-training-canada/. As always, training online for groups and individuals is available.
We also offer professional development webinars on various topics found at https://sassi.com/other-training-online/. On the top of that page there is a link to complete a form to request a quote for a private in-person or online training.
Stay safe and be well.
SASSI Identifies Rx Abuse (with video)
‘Reggie’ is a 37-year-old married man. He and his wife have two children. He works as a warehouse worker where he was recently injured in a shipping dock accident. He recently returned to work after being on worker’s comp for several months during which time he was prescribed opioids for his pain. He was sent to his employer’s EAP provider for evaluation after returning to work and struggling with coping with the continued pain and poor job performance.
Reggie T’s responses illustrate another profile often seen in people who acknowledge that they use drugs excessively and that it negatively impacts on their functioning and relationships.
Given Reggie’s high level of drug use and consequences, you might consider a more comprehensive evaluation to determine whether he may need supervised detoxification or other intensive intervention.
You may find Reggie ready to acknowledge that he uses drugs frequently and that he may also drink too much. However, he may not see that his behavior varies dramatically from others who don’t have a substance use disorder. Feedback on where his scores fall on the profile sheet may help him see that his behaviors are not typical. It may be useful to know that Reggie’s wife is currently in treatment for drug and alcohol abuse due to a DUI. Their mutual abuse of substances may help promote their beliefs that their substance use is normal. Examining the items that Reggie endorsed on the FVA, FVOD, SYM and Rx scales may provide useful insight into his motivations for using and help him see the consequences that result from his use.
In this first video watch Reggie’s initial EAP visit in which he was asked to take the SASSI.
This second video is the follow-up session where he discusses his SASSI results with the EAP provider.
BADDS Sample Report
Mr. M. is a 38-year-old Caucasian male, presenting to the DUI Court with a second DUI offense. His first offense occurred and he was sentenced to time served (1 day), one year probation, paid a $500 fine, and his driver’s license was suspended for 90 days. Mr. M.’s probationary period from his first offense ended successfully.
A year later, Mr. M. was arrested and entered into a no contest plea for drinking and driving under the influence. Mr. M. went before the court and asked for leniency on his conviction, yet expressed willingness to comply with any recommendations set by the court. Judge sentenced Mr. M. to 2 days served in the county jail followed by 2 years of DUI Court participation and 12 months driver’s license suspension.
Background Information: Mr. M. is a manager at a local insurance firm, where he has worked for the past nine years. Mr. M. has a bachelor’s degree in business from a state college. Mr. M. is married and has two young children. Mrs. M. is employed full-time as a teacher.
Medical and Mental Health History: Mr. M. is of average height and weight. He stated that his health is very good without significant medical problems, except for a back injury that he sustained last year that continues to cause him pain. Mr. M. does smoke cigarettes. He has a family history of cardiovascular disease and high blood pressure. Mr. M. did not report any history of mental health problems of his own or in his family.
Substance Use History: Mr. M. reported that he began drinking when he was 17 years of age during his senior year in high school. Mr. M. stated that he drank on weekends “with the guys” while in school and reported his use as “normal.” He maintained above a 2.5 grade point average throughout college and did not report any alcohol violations during this time. He did report drinking to intoxication approximately two to four times per month.
After college, Mr. M. was hired by his current employer. He reported that during his years with the company, he received excellent evaluations and was quickly promoted to his current managerial position. Mr. M. stated that after his first DUI conviction, he has tried to maintain a “no drinking and driving” policy and limits his alcohol intake to weekends only.
Mr. M. attributed his recent absences from work to lower back pain. Mr. M. denied drinking in the morning, withdrawal symptoms such as shaking or sweating, or loss of control of his use. He denied experiencing any recent blackouts or other behavioral changes.
DUI Court Intake: The County DUI Court uses the Behaviors & Attitudes Drinking & Driving Scale (BADDS) at entry into the program and following the approximate two years of participation in drug court activities. Mr. M.’s BADDS results follow.
BADDS Pretest Results: Mr. M. has high scores on four scales: Rationalizations for Drinking and Driving (RD: 27), Lenient Attitudes (LA: 29), Likelihood of Drinking and Driving (LD: 35), and Drinking and Driving Behaviors (DB: 03). Mr. M. scored in the moderate range for Riding Behaviors with a Drinking Driver (RB: 01).
Mr. M.’s responses on the alcohol use and history items, in contrast to his stated attempts to limit his drinking to weekends, revealed that he drinks alcohol daily. Responses also showed that either he or someone significant to him has been in an alcohol-related accident. Despite his best efforts to refrain from drinking and driving, Mr. M. acknowledged that he drove under the influence and rode as a passenger in a vehicle of someone who had been drinking, within the month prior to his arrest.
Mr. M.’s high scores on the RD, LA, LD, and DB scales indicate that he has endorsed and acted upon risky beliefs and attitudes about drinking and driving. In addition, his responses on the LD scale suggest that it is acceptable to him to drive under certain circumstances after having at least three or four drinks. Mr. M.’s perception about how many drinks he can consume in one hour and drive safely and legally is just below probable legal limit based on his body weight. Further, Mr. M.’s RB score indicates that he has recently ridden in a vehicle with an impaired driver.
Summary and Recommendations: Mr. M. enters into the DUI program as a sentencing requirement set by Judge Andrews after completing a 2-day incarceration.
Mr. M.’s BADDS results indicate that he is a suitable candidate for a DUI program that would help him learn about the risks of drinking and driving, and examine his beliefs about safe driving behavior. In addition, an evaluation for substance use disorder will be conducted in the next session with Mr. M. Without intervention, Mr. M.’s scores suggest that he is at high risk of recidivism. The re-administration of the BADDS prior to his completion of the DUI court program would help to assess if there has been change in his risky behaviors and attitudes that could continue to put him at risk for further problems with impaired driving, if they are not adequately addressed.
A SASSI-4 Profile Analysis: Reading Aloud the Questionnaire and Interpretation of Low Scores
We regularly get inquiries about the acceptability of reading the questionnaire to a client who may have difficulty with their reading skills. We discourage the evaluator from reading the questionnaire to the client for a variety of reasons, but the primary one concerns the validity of the results. No matter how careful the reader might be, the tone of voice or emphasis on a particular part of the question may lead the client in one direction or another. Or the client may interrupt with a question regarding the meaning of a word or intention of a particular question. This is why we offer a professionally read audio CD of the SASSI-4, Adolescent SASSI-A3 and Spanish SASSI paper and pencil versions for clients who have reading difficulties. We hope in the future to be able to offer this for the online platform as well. Please contact our customer service department for ordering information.
Another frequent question is related to the clinical interpretations of the “low” scores on the profiles. These mostly relate to the subtle scales which include the OAT, SAT, DEF and SAM scales. Most callers know what a low DEF indicates. And SAM has no clinical interpretation.
So what about those low OAT and SAT scales? What does “low’ mean? A low score is anything below the 15th percentile on the graph. In the example to the right, the caller indicated that she was doing an assessment on a health care professional who had been arrested for her one and only DWI the previous year, had completed her alcohol education class and needed this evaluation as a final step for probation. She was not in trouble in her job and in fact, highly regarded in her profession. Given the client was at the end of her requirements, the evaluator was somewhat concerned with the results and what it meant. The instructions were given to answer the FVA/FVOD side for the last twelve months. Her RAP is zero. Her Prescription Drug Scale is zero. She has ‘no’ on all the rules so came up with a Low Probability of having a Substance Use Disorder. However, her DEF of 9 is highly elevated. Elevated DEF scores increase the possibility of the SASSI missing individuals with a substance use disorder. Elevated DEF may also reflect situational factors. Note that the SAM is within the norm so it is probably more likely that her DEF is situational given the context. She also has an OAT score of ‘O’ and a SAT score of ‘2’. Both are below the 15th percentile. A low OAT indicates someone has difficulty acknowledging personal limitations or shortcomings. A low SAT indicates someone who might have a ‘chip’ on her shoulder, a hypersensitivity to others or feelings of rejection.
So even though this client is nearing the completion of her probation requirements, we still get a picture of someone who is highly guarded (DEF), has a hard time acknowledging shortcomings (OAT) and may continue to exhibit resentment (SAT) for the situation she is in. Perhaps this is due to her profession, or perhaps it is her personality. What the results give the evaluator is clinical direction on how to approach the client to help reduce her defensiveness and give her permission to open up. Affirming how demanding her job is and how on top of things she must be could be a pathway to discussing her feelings of shame related to the DWI and how it might be affecting her self-esteem. Could she be minimizing her use of alcohol and drugs? Perhaps, but as we strongly express, the SASSI is only one part of a clinician’s assessment. Hopefully, with the input of all the information you have, the clinician can evaluate the results which fit the context for this client.
The Power of Narrative Therapy
Last month, Dr. Hugh Marr, a longtime trainer on the SASSI and clinical psychologist in the private practice of psychotherapy in the Washington, DC area gave an interview on the Shrink Rap Radio podcast. Dr. Marr has taught both substance abuse counseling and psychotherapy at area universities; and has worked in all phases of community mental health, culminating in running a partial hospital program for clients with the co-occurring disorders of substance use and major mental illness. He is the author of A Clinician’s Guide to Foundational Story Psychotherapy: Co-changing Narratives, Co-changing Lives (Routledge, 2020); and the coauthor of the books What Story Are You Living? (CAPT, 2009) and Introduction to Archetypes (CAPT, 2002). His forthcoming workbook for a general audience, also to be published by CAPT, will be titled Finding Your Story. You can view a clip from that interview here or a link to the interview in its entirety can be found here.
The SASSI Institute is excited that Dr. Marr has developed a workshop based on his five-star rated book: A Clinician’s Guide to Foundational Story Psychotherapy: Co-changing Narratives, Co-changing Lives. This workshop is being offered through The SASSI Institute’s Professional Development Platform. A link to a flyer with additional information on the workshop can be viewed here.
We hope you enjoy the interview and that you will join us for this informative webinar.
To register for the webinar and see our other titles, click here.
Turning the Corner on COVID-19
Dear Friends,
For more than a year now, our lives have been literally turned upside down. Many of us have lost loved ones and friends or had them severely affected by this terrible pandemic. It has caused upheavals in basically all areas of our lives.
But I think it is safe to say that we are finally turning the corner. Science tells us that the required herd immunities and vaccinations are soon to be at optimal levels. Here at The SASSI Institute, we are at more than 95% capacity. And I am so proud of our staff, their dedication and professionalism as they continued to serve you, the heart of our business. They were with you through thick and thin, and despite the multiple obstacles, collectively we accomplished an extraordinary level of achievements throughout this time. For example, we have multiple publications that are now in the public domain. Please contact our Customer Service Team if you are interested in any of them, they are free of charge. If interested in our Training services and availabilities, contact our Training Director Ms. Scarlett Baker, or our Executive Assistant, Ms. Lauren Nelson. Kristin Kimmell LMSW, LCAC, our Clinical Director and her team are available for any of your clinical concerns. And by the way, Lauren also serves as our IT specialist, so she is available for any mishaps in your IT service provision.
In sum, I am very proud of you, our customers for maintaining our collaborations, our staff for making that possible, and to the many, many individuals we serve, may their path to recovery be enlightened by your services.
With warm regards,