In this Issue...
The staff of The SASSI Institute and I are grateful for the opportunity to join you in the Springtime of both a New Year and a New Millennium in your ongoing efforts to help people whose lives are hurt by substance dependence and abuse. We trust that you are continuing to find the SASSI to be a valued and integral component of your assessment programs.
It is a pleasure at this time to announce the availability of the adult SASSI-3 Manual. We sincerely hope you will find it a useful aid in gaining a better understanding of the SASSI-3 as you seek to help your clients. Although this manual is intended to be more technical in nature than the SASSI-3 User's Guide, it was designed to be useful to readers from various backgrounds and work settings. For example, the chapter on development and validation is technical in nature, but an attempt was made to present the material in a way that allows people who do not have a background in statistics to gain a better understanding of the strengths and limitations of the SASSI-3. Another chapter contains valuable information on clinical issues that can be addressed with the instrument - severity of substance dependence, substance abuse, level of acknowledgment, emotional pain, risk of criminal behavior, focus on others, etc.
In this issue of News and Reports, we have included an excerpt from the new SASSI-3 Manual that addresses one aspect of substance-related disorders. It often is said that substance dependence is a "cunning" disorder because it evolves gradually, and the victim often is not able to recognize and accept the reality of the problem. The excerpt presented here highlights the importance of early identification and treatment as a way to prevent some of the pain and cost incurred as substance use disorders evolve and gain strength.
The profile interpretation of "Carol" that is contained in this issue also addresses the importance of helping people gain awareness of their substance misuse. Carol is one of the four fictitious clients portrayed in our instructional video, "Connecting Clinician and Client," which demonstrates clinical interpretation and feedback using the SASSI-3.
Remember that our clinical staff members are here to discuss and help you with any profile results or interpretation issues that may arise. Contact them toll-free at 888-297-2774.
As always, we invite your comments and suggestions on any SASSI materials or services. We thank you for your continued support and most of all, for your valuable contributions to the field of addictions.
This excerpt discusses some of the characteristics of "Carol," whose SASSI-3 profile is presented in this issue of News and Reports. (See below.) Carol suffers from alcohol dependence, and she is an adult child of an alcoholic mother. Her case is also presented in the video, "Connecting Clinician and Client."
Substance dependence often functions as a primary disorder. Substance dependence is heterogeneous in regard to course; there are various pathways that substance dependent people travel. Some of the people who meet criteria for a positive diagnosis may enter a remission status without direct intervention; life changes and effective intervention into other problems may, at times, restore health and well-being. On the other hand, many of the people who are diagnosed as substance dependent are not likely to reverse the course of the disorder unless it is addressed directly. Regardless of the primary cause, the substance dependence itself can evolve into an autonomous disorder that is maintained despite changes in the status of the causal factors. Thus, while life-style changes may ameliorate the problem in some instances, it is often necessary to identify substance dependence as a primary disorder and provide specialized treatment for it. The SASSI Institute, therefore, seeks to promote early identification and treatment of substance dependence.
Substance dependence has a negative impact on significant others. Substance misuse can lead to interpersonal, financial, and legal problems that are borne by family members. Significant others may also experience less direct problems that can be equally devastating. Family members, friends, and coworkers of substance dependent persons often learn patterns of behavior, cognitive responses, and emotional reactions which ultimately prove to be unhealthy for themselves but provide a means of surviving in a social sub-system that is dominated by substance misuse. As significant others adapt to the centrality of the dependent person's never-ending needs, they may lose sight of their own needs. Some even undertake the impossible task of controlling the affected person's substance misuse. Such habits can become part of the general coping style of family members and other associates of people who abuse alcohol or other drugs. As a consequence, spouses, children, parents, coworkers, and friends who are heavily involved with a dependent person may lose part of their capacity to experience life in a serene and joyful manner. Early identification and treatment of substance dependence can, therefore, serve to prevent some of the emotional pain experienced by significant others.
Recovery is a process of courageously seeking to make the changes necessary to enjoy a rich and satisfying life. Addictions counselors know the thrill of witnessing the journey of self-discovery as a client begins to come to terms with substance dependence. For most clients, these issues have been too frightening to contemplate. While they are using, substance dependent people are often unable and unwilling to accept and acknowledge the magnitude of their substance misuse and the negative impact it has on their lives. When consumption of psychoactive substances is both the problem and the primary coping technique, there appears to be no way out. As they face crises in their lives, substance dependent people often need help to see the extent and consequences of their usage. When they gain clarity and perspective, they are able to take the courageous step of letting go of a means of coping that is leading them into pain and toward premature death. The SASSI Institute is dedicated to providing an instrument that can help substance dependent people gain the awareness necessary to transform their lives and thereby restore health and well-being.
In this issue of News and Reports, I would like to review a case that is presented on our instructional video, "Connecting Clinician and Client." The video portrays the process of using the SASSI to help clients gain greater awareness and begin the process of recovery. The following case is a good illustration of a client who lacks awareness and insight regarding the way in which her substance dependence is impacting her life. As we will see, this element of the client's presentation is clearly reflected in her SASSI results.
The client, Carol, is a 43-year-old married female, a successful businesswoman and mother of two children. She recently was arrested and charged with her first DWI after leaving a business dinner with sales associates. This is the first significant consequence related to her drinking. She claims that she does not have a drinking problem; however, she characterizes her mother as an alcoholic.
[NOTE: Please photocopy an adult female profile form and plot the scores as follows:
FVA=10; FVOD=3; SYM=4; OAT=2; SAT=6; DEF=8; SAM=6; FAM=13; COR=5; RAP=0.
As we take a look at her scores, first notice that Carol appears to have responded in a meaningful way to the items on the SASSI-3 (RAP=0). However, there is some evidence that she may have approached the assessment process in a defensive manner (DEF=8). Despite her apparent defensiveness, the SASSI results indicate that she has a high probability of having a substance dependence problem (SAT=6 leading to a positive on decision rule 5).
Given the elevations on the SAT and DEF, we get the sense that Carol may have some difficulty recognizing (high SAT) and acknowledging (high DEF) the nature of her substance-related problems. Yes, it is true that she reports significant problematic use of alcohol (FVA=10). However, it will be important to review with her the content of her responses on the face valid alcohol scale in order to gain some understanding of how she views these consequences. Our experience with the SASSI and our knowledge of the nature of the addictive process suggest to us that individuals who have elevated SAT and DEF scores (especially when OAT is average or below, as is the case here) often have difficulty seeing the manner in which their drinking has pervaded other areas of functioning. Therefore, it is reasonable to expect that much of what she has reported on the FVA may be flavored with a theme of, "I'm so embarrassed about these things, but thank God I don't have a problem."
Carol's FAM score is elevated (13), suggesting that her responses are similar to individuals who have a history of being in relationships with others who are substance dependent. This is often related to a tendency to focus on others and a need to try to control the external environment. Elevated scores on SAT, DEF, and FAM suggest that Carol is likely to have an exceptionally strong tendency to deflect attention away from any suggestion that it is important for her to make significant changes in her life. Carol's lack of awareness and insight may not only be rooted in her own addictive disorder but may also be fostered by a long history of trying to cover up for her mother and feeling responsible for the family's welfare.
This process is illustrated in the video, in which Carol touches on the pain of her childhood by going into a lengthy discourse on what it was like to live with and cover up for her alcoholic mother. As Carol voices her pain, she is also directing attention away from herself. It is hard for her to face an uncomfortable personal issue, like getting arrested for a DWI, and she sincerely believes that she is not part of the problem. In the video, Carol presents a "how to clinic," if you will, on focusing on the ills of others and diverting attention from her own problems, while having no awareness that she is engaging in this process.
Treatment Recommendations:
Despite Carol's inability to see her substance misuse as a serious problem in her life, the SASSI results clearly indicate that she is likely to meet the diagnostic criteria of a substance dependence disorder. Therefore, effective treatment planning will need to include some form of addictions therapy, most likely at the outpatient level of care. The therapeutic challenge for the treatment provider will be to establish a working relationship with Carol that is conducive to helping her explore the substance abuse issues in her life. This usually means starting where the client is and moving her in a direction of increased awareness and insight regarding the nature of her own substance abuse problems and the changes that can help her begin a process of healing and recovery.
Carol comes to the treatment setting with recognition of her mother's alcoholism. She has a desire to disclose information about her life growing up with an alcoholic mom. This gives the treatment provider a naturally occurring place to begin. As Carol bonds with her therapist in the work of resolving the pain of her childhood, the therapist can help her examine the significance of her own alcohol usage. The therapy can be augmented by support groups in which Carol can learn from the experiences of others who come from similar home environments and from other people who have had to struggle with the reality of their own addiction problems.
Ongoing assessment will be helpful during this process to monitor her progress and make adjustments in the treatment plan as necessary. For example, if she is unable to refrain from using, has additional alcohol-related social or legal consequences, or becomes non-compliant in the treatment process, it may be necessary to move to a more intensive level of care.
The emotional impact of growing up in an environment that is dominated by the pain and shame of addiction takes many forms and can exert its influence throughout a person's life. Carol's DWI can be a gift. With appropriate intervention, Carol can begin a process of self-examination and growth that will lead to a freer, richer life.
Research efforts are constantly underway here at the Institute to provide new and updated materials for your use. We continue the painstaking task of gathering and analyzing data for our two top priorities: the Spanish SASSI and the Adolescent update. We realize that many of you have been waiting for those instruments for some time. The process of collecting sufficiently large samples of data to produce reliable, valid and useful instruments has required a longer timeframe than we originally estimated, particularly with the Spanish version. We hope to reward your patience in the not too distant future.
As I am sure all of you are aware, there is a pressing need in the addictions field for reliable measures of treatment effectiveness. The SASSI Institute has undertaken development of two outcome measures, the SASSI ATOM (Addictions Treatment Outcome Measure) and the SASSI QRI (Quality of Recovery Index). We will keep you updated on the anticipated release of these instruments.
We wish to take this opportunity to thank all of you who have collaborated with us in our research projects by providing us with data. We are extremely grateful for your time and efforts - your support is vital as we endeavor to refine and develop assessment tools to help in the process of identifying and treating substance use disorders.