In this Issue...
The following is intended as a quick reference guide for SASSI users desiring assistance with the administration, scoring, and interpretation of the SASSI-2. For more detailed information, you may want to refer to the SASSI manual or simply contact us at 800-726-0526, and we will be happy to assist you.
PURPOSE OF THE SASSI-2
SASSI-2 was designed as a substance abuse screening measure that: a) does not require a professional's time to administer; b) is brief; c) is objectively scored; d) leads to classification of individuals by the use of clear decision rules; e) is accurate; and f) is composed primarily of "subtle items" that appear to be unrelated to substance abuse, thus enabling the instrument to identify some individuals with substance-related disorders even if they are unable to acknowledge relevant symptoms.
The primary purpose of the SASSI-2 is to identify individuals with a high likelihood of having a substance-related disorder. The decision rules identify individuals who have a high probability of having a substance dependence disorder. The available data indicate that approximately 88% of individuals with a psychoactive substance-dependence disorder will be test positive on the SASSI. Also, about 88% of individuals who are not substance dependent are correctly classified by the SASSI. Thus, individuals who are test positive by the SASSI-2 decision rules are highly likely to meet criteria for a diagnosis of psychoactive substance dependence. The process of assigning a DSM-IV or ICDM diagnosis requires information about the use of specific substances and the presence or absence of specific symptoms.
A secondary purpose of SASSI-2 is to provide clinical information that can be useful in the process of helping identify problem areas, set treatment goals, and develop treatment plans. Use of the SASSI for the past seven years has led to tentative conclusions regarding the clinical meaning of some of the scale scores and profile configurations. These findings have not been subjected to full empirical investigation. Therefore, broad interpretations of SASSI scales and profiles should be viewed as providing a supplementary source of information to aid in the clinical process. Depending on the availability of resources and the goals and values of the treatment provider and client, interpretations of the SASSI-2 scale scores and profiles can be used as a source of information for formulating treatment plans.
In light of the broader social and economic impact of substance-related disorders, there is an increase in substance abuse screening being conducted outside the health-care field. Some of the settings in which substance abuse screenings are being conducted are legal/judicial, employment, sensitive industries, and government services. The SASSI Institute supports use of SASSI-2 in those contexts to the extent that the instrument is used to promote the health and well-being of the individual and that it is not used as a basis of discriminating against people. The staff at The SASSI Institute are available for consultation on specific applications of the instrument. In some instances, arrangements can be made for developing customized programs to meet specific program needs.
The samples that were used to collect the data for formulating and cross-validating the SASSI included members of minority groups. The SASSI scales do not correlate with age, sex, and socioeconomic status. Thus, the SASSI is likely to be effective with a wide range of clients. However, the possibility exists that an individual's unique demographic characteristics may have an effect on the probability of an erroneous classification.
No detailed instructions are required when administering the SASSI-2 in either individual or group assessment situations. It is advisable to put clients at ease by eliciting their cooperation in providing information that can be of value in addressing their needs. To avoid defensiveness, refer to the SASSI-2 as a questionnaire rather than a test. Also, ask the clients to complete the 62 true/false items prior to turning the questionnaire over to complete the 26 items that directly address substance abuse. If clients are going to be given feedback, it is a good idea to let them know they will have an opportunity to discuss the results with a counselor, as this tends to lower anxiety and increase cooperation.
Remind clients to complete every item and to give only one response to each item. Acknowledge that the decision to answer "true" or "false" may be difficult on a few questions but that it is important that they choose only one response on each item. Do not give advice to help a client choose on any given item. Rather, inform them that there are no right or wrong answers and that you are interested in their opinion. If possible, check to see that the client has provided a single answer to each item.
If clients have literacy or vision limitations, it is permissible to read the items or use the available audio tape. When possible, it is preferred that clients mark the answers on their own copies without the person administering the questionnaire being able to see their individual responses.
Scoring the SASSI-2 involves obtaining numerical scores for each of the nine scales. The scale scores are then transferred to the profile sheet. You may use the sample test that is included in the Introductory Kit while going through the following instructions.
THE REMAINING SEVEN SCALES ARE TAKEN FROM THE 62 TRUE/FALSE ITEMS AND ARE SCORED WITH THE PLASTIC SCORING TEMPLATE.
FOLLOW THE SAME PROCEDURE FOR THE REMAINING FIVE SCALES.
The instructions to clients for completing the face valid items do not specify a time frame. Thus, individuals who have been abstinent, or who have not experienced problematic usage for an extended period of time, may be classified as chemically dependent on the basis of acknowledging past behavior. For many clinical applications, it is important for the clinician to determine the recency of the behaviors acknowledged on FVA and FVOD.
Clinical experience has shown that elevated scores on OAT reflect a tendency to acknowledge behaviors and personality characteristics commonly associated with substance abuse, e.g., impulsiveness, low frustration tolerance, impatience, resentment, self-pity. Clients with elevated OAT scores are often readily able to relate to and identify with substance abusers, including those in recovery (for example, in addictions films and self-help groups). They tend to be open to feedback, although they are not always receptive to the idea that it is in their best interest and within their capability to change.
Clinical experience has shown that elevated scores on SAT reflect a tendency for individuals to be detached from their feelings and to have relatively little insight into the basis and causes of their problems. People who have a substance-related disorder and high SAT scores often find it difficult to fully accept the significance of substance usage in their lives. Particularly when SAT is the highest elevated scale, the client may present as having few symptoms.
Clinical experience has shown that elevated scores on DEF reflect a tendency to avoid acknowledging any signs of personal limitations and faults. Individuals with high DEF scores may focus on blaming other people and external circumstances for their problems. They may therefore find it difficult to fully engage in a treatment process.
Clinical experience has also shown that a low DEF score is indicative of emotional pain. A DEF Score below T-40 may not simply reflect low defensiveness, but rather a tendency to be overly self-critical. This can result from problems with self-esteem and can be related to symptoms of depression such as a loss of energy, a sense of hopelessness, and suicidal ideation.
SUPPLEMENTAL SCALES (FAM AND COR)
FAM is not used in the decision rules. It is included in SASSI-2 as a source of supplementary clinical information. Clinical experience has shown that high FAM scores are indicative of a tendency to focus on others. Clients who have elevated scores on FAM are likely to have problems in such areas as establishing a sense of personal power and setting limits with others.
The COR Scale is not part of the SASSI-2 decision rules for chemical dependence. The scale identifies individuals who may be at relatively high risk for legal difficulties. It is intended to be used as a source of information that can be useful in identifying treatment needs and developing treatment plans. It is not intended as a tool for diagnosing any type of psychopathology, including psychopathy, sociopathy, and antisocial personality disorder. COR is a relatively new scale; at this time The SASSI Institute is unable to provide recommendations for more detailed interpretation of the clinical meaning of the COR Scale score.
SASSI-2 profiles provide information that can be useful in suggesting possible treatment issues.
Clients who have DEF scores below the T-40 line may be in considerable emotional pain. A DEF score that low may reflect more than a low level of defensiveness; it may reflect a tendency to be overly self-critical. This can result from problems with self-esteem and can be related to symptoms of depression such as a loss of energy, a sense of hopelessness, and suicidal ideation. It is often important to explore these possibilities in a more comprehensive assessment. Clients with low DEF scores typically respond well to a therapeutic approach based on acknowledging their pain.
Because the COR Scale is so powerful, misunderstanding or misinterpretation could have serious consequences. It is important to recognize that although the COR Scale has proven to be quite powerful in cross-validation, the available data reflect on its concurrent validity. Hopefully, longitudinal research will further clarify the predictive power of the scale. In other words COR has been shown to be highly associated with a history of criminal behavior, but it has not been tested as a predictor of future criminal behavior. It is also important to recognize that the COR Scale is presented as a measure of relative risk of criminality; it should not be used to make specific predictions about the likelihood of criminal behavior.
Elevated FAM scores appear to be related to a tendency to focus on others in a variety of ways. Some clients find it difficult to recognize and address their own needs; some clients have a tendency to act in a blaming and judgmental manner; some clients fixate on the frustrating task of getting other people to change; many will appear to be similar to "enabling care givers." Treatment is often enhanced by providing education in family systems theory. It is often challenging to help these types of clients get past their goal of becoming more effective in influencing and controlling others. It is important to orient these clients to the idea that they are in treatment to find ways in which they can make changes in themselves to enhance the quality of their lives.
RESEARCH AND DEVELOPMENT
PROVISIONAL SPANISH SASSI AVAILABLE FOR FINAL TESTING
The SASSI Institute is pleased to announce that a provisional Spanish SASSI has been sent to the printer for production. Following extensive testing, we are able to endorse use of the provisional Spanish SASSI for clinical purposes.
To further ensure the accuracy of the Spanish SASSI, we have decided to conduct a final round of testing. We are therefore providing it to clinicians who conduct diagnostic assessments on Spanish-speaking clients and are able to share data with us. We welcome contact from service providers who regularly conduct addictions assessments on monolingual Spanish-speaking clients (contact Mike Boye or Frank Miller at The SASSI Institute, 800-726-0526 or send E-mail to firstname.lastname@example.org).
As I indicated in prior issues of News and Reports, we have been highly aware of the need for an addictions screening instrument for Spanish-speaking clients. We have received calls from many clinicians who said that they need one now. We regret that we have not been able to meet that need. However, we wanted to provide you with a well-developed and well-tested instrument and therefore have been involved in a lengthy research process. We have made the final turn into the home stretch and are excited by the prospect of making a Spanish version of the SASSI available for your use.
Glenn, Linda, Mike and I are grateful for all the support SASSI users have given the research department. Our aim is to provide you with as useful an instrument as possible, and we rely on your help to do so. Thank you.
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