In this Issue...
As many of you know, Glenn began work on the SASSI when he was commissioned by a large metropolitan court program to develop an assessment and referral system for people who were arrested for driving under the influence. The SASSI was designed to address two important issues that arise in processing DUI offenders: 1) people who are facing legal penalties are not always forthright in reporting their usage and its consequences; 2) there are too many arrestees and not enough trained personnel to assess them. During the course of conducting assessments in the DUI program, one man tried to assure Glenn that he would never drink and drive again: "I rented an apartment right over the bar."
Would that it were true: The man may have indeed rented an apartment over the bar, and he may have sincerely intended to never drink and drive again. If driving under the influence were simply a matter of poor judgment, I would be reasonably confident that he would not drink and drive again. But consider: About one-third of the people who are arrested for driving under the influence have had prior arrests for driving under the influence, according to the National Highway Traffic Safety Administration (NHTSA). One survey found that 86% of prisoners currently in jail for DUI had previously been sentenced to probation, jail, or prison for DUI or for other offenses. One out of eight intoxicated drivers involved in fatal crashes has had a prior DUI conviction within the past three years, according to NHTSA data.
Obviously, many people who incur the personal, financial, emotional, and social penalties associated with arrests for driving under the influence repeat the offense. Many people drink and drive with the full knowledge that police set up roadblocks and screen for driving under the influence on holidays such as Labor Day. Are they all simply showing poor judgment? Probably not. It is estimated that approximately half of the people who are arrested for drinking and driving could be diagnosed as having a substance use disorder. One of the symptoms of substance abuse and substance dependence is continued use despite recurrent problems.
Within the population of DUI offenders, there is considerable variability in regard to crucial causal factors, including the extent and severity of alcohol problems. When some people incur the financial loss, shame, and guilt associated with being arrested for driving under the influence, they never do it again. However, some people continue to have alcohol and other drug-related legal difficulties until they make the significant and basic changes that are a part of the process of recovering from substance dependence. It is also important to recognize that some DUI offenders have other types of problems in addition to substance misuse; driving under the influence can be related to personality and social factors that engender risk-taking behavior. Because of the variability among DUI offenders, it is essential to assess each offender and match the person to appropriate treatment in order to reduce the terrible cost of driving under the influence.
Now let's go back and revisit Glenn's client: Maybe his alcohol problems and his personality are such that he would indeed never get so drunk that he would lose awareness of the consequences of driving under the influence and break his commitment to not drive while intoxicated. Maybe he could live a long and satisfying life on top of the bar. But like many untreated substance dependent individuals, he may increasingly center his life on alcohol and thereby move toward depression, despair, and early death.
Public policy in regard to driving under the influence is appropriately directed toward protecting the public from DUI offenders. We offer treatment because we know that treatment is necessary to reduce recidivism and thereby lower the incidence of driving under the influence. But it is important to recognize that, in the process, we are also saving the lives of some perpetrators who are themselves victims. In providing them with treatment we are making our streets safer, and we are giving them a chance for an enriched life.
SASSI-3 Profile Interpretation
In this issue of News and Reports, we will be presenting one of the example profiles found in the SASSI-3 User's Guide (pp 44-45). The following review will hopefully provide you with additional insights regarding the nature of the client's problems and the associated features of a viable treatment plan. My comments will be presented as if this were a profile called in to our clinical support line.
Bob B. is a 43-year old male who was referred by his attorney for a substance abuse evaluation following a traffic fatality in which he was driving under the influence. (See Sample Assessment Report on page ___ of this newsletter.) Mr. B. seems to have understood the items and responded in a meaningful way (RAP = 0). There is no significant evidence that Mr. B. was defensive (DEF = 7).
The most salient feature of the profile is the significantly elevated SAT score, which is a key feature in both decision rules that lead to a test positive on the SASSI (Decision Rules 5 and 6). His responses were highly similar to substance dependent individuals regardless of their ability or willingness to report symptoms relevant to substance misuse. Given the lack of evidence of defensive responding, it's likely that Mr. B. falls in the category of those who are unaware of the full impact of substance dependence problems in their lives.
Individuals with this configuration of scores are often willing to acknowledge some behavioral problems related to their substance use. Mr. B. demonstrates this by acknowledging significant current and/or past alcohol (FVA=12) and drug (FVOD=10) use. His pattern of responding also indicates some awareness of behavioral problems that are commonly associated with substance dependence: low frustration tolerance, self-centeredness, grandiosity, etc. (OAT=7). However, given the elevated SAT, he will most likely not be able to make any connection between his acknowledged use and behavioral problems and their impact on other areas of his life.
He also responds in a fashion similar to individuals who live in an environment dominated by substance abuse (SYM=5). Although the SYM is not extremely elevated, it does tend to support the notion that Mr. B. may view his substance use as normal. Further content analysis may reveal additional factors about his life circumstances that might be important to consider in treatment planning.
Mr. B. may be relatively well presented. He may also appear to be emotionally detached while maintaining a sense of pragmatism regarding his situation. Relatively poor insight and self-awareness are commonly present in these types of profiles. It's not that Mr. B. refuses to understand or is intentionally resistant; he literally doesn't grasp that his substance use may be a problem that requires further exploration. In his mind, external factors or stressors may be to blame for his current predicament. The possibility that this tragic incident may be directly related to a substance dependence problem would be quite difficult for Mr. B. to understand at this time.
In light of Mr. B.'s lack of awareness, he may need special help to engage in a process of change. Efforts directed at forcing him to accept his substance dependence may be counterproductive. Although an ultimate treatment goal would be greater awareness and expression of feelings, cognitively oriented interventions may be more effective initially. Individuals with high SAT scores are sometimes able to acknowledge a sense of something missing in their lives but aren't sure what it is. Further exploration in this area may lead to some identification and personalization of a problem that he can accept. Assisting Mr. B. in the expression of feelings associated with the problem may ultimately help him to define a need for change in a way to which he can commit. This approach would hopefully establish the groundwork leading to further investigation of the nature of Mr. B.'s substance dependence and what changes would help him come to grips with the tragic consequences of his substance misuse and enhance the quality of his life. Referral to community self-help support groups would also be an effective way to increase personal insights that may lead to further processing of feelings.
Mike Boye has been doing a great job working on the Spanish version of the SASSI. Last year at this time we began distributing a provisional Spanish SASSI. The goal was to provide you with a Spanish addictions screening tool while we collected data for further modifications and cross validation.
In producing a Spanish version of the SASSI, it is our position that it is not sufficient to simply translate the instrument and assume that it will be accurate and effective. Prior to distributing the provisional Spanish SASSI, we worked with two professional translators and developed three translations. We examined data from 113 research participants. We obtained an overall accuracy rate between 80% and 85%. We anticipated that as additional data came in, we would be able to adjust the decision rules to increase the accuracy, conduct cross-validation analyses, and be ready to provide you with a highly accurate, useful, robust instrument.
SASSI users who work with monolingual Spanish-speaking clients provided us with data on approximately 1,600 people. Regrettably, the provisional Spanish SASSI that we distributed last summer did not meet our standards of accuracy. We are therefore planning to develop new items, assess their effectiveness in identifying substance dependent people, and devise new decision rules.
At this time we are stopping shipment of the provisional Spanish SASSI. We are aware of the pressing need for an addictions assessment instrument for Spanish-speaking clients, and we are doing everything we can to develop one and make it available to you. We will be collecting additional data within the next few months, but we are unsure when we will be able to have a version available that we can recommend for clinical use.
We are committed to ensuring that the Spanish SASSI is based on a solid foundation of research and that it meets our standards of accuracy. As always, Mike welcomes calls from people who are working with Spanish-speaking clients.
As a corporate sponsor, we recently attended the National Drug Court Conference held in Los Angeles. We were pleased to see the advances in the field of addictions and feel that drug courts play a key role in promoting public health and safety and, ultimately, in saving lives. The SASSI Institute is pleased to support drug courts in their efforts on behalf of individuals and families with alcohol and drug problems