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.
Tag: The SASSI Institute
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.
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 System | Peripheral Nervous System |
| Autonomic Nervous System | Somatic Nervous System |
| Sympathetic Nervous System | Parasympathetic Nervous System |
| How the Brain Works | Tolerance and Cross-Tolerance |
| Rebound / Withdrawal | Drug Half Life / five to eliminate |
| THIQ in Alcohol Metabolism | Dopamine Depletion by Cocaine |
| Determining BAC by number of drinks consumed |
The following drugs/drug classes will be examined:
| Opioids | Alcohol |
| Sedative-Hypnotics | Cannabis Sativa |
| Cocaine | Sympathomimetics |
| Inhalants | Hallucinogens |
| Club Drugs | Caffeine |
| 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.
Profile Configurations: When the OAT is higher than the SAT vs when the SAT is higher than the OAT
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?
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.