Here we showcase examples of SASSI interpretations, to demonstrate the kind of information the SASSI can offer, and the ways in which it can be used to inform initial approaches with the client, engage and draw them out, and inform care planning and / or report writing.
This month’s profile is that of a 15 year old adolescent male. The adolescent scale scores (only*1) have been used to generate this résumé:
Adolescent SASSI – 15 year old male
FVA 5, FVOD 5, FRISK 5, ATT 7, SYM 3, OAT 6, SAT 3, DEF 7, SAM 5, COR 9, VAL 1, SCS 20
The SASSI indicates that this young person has a high probability of having a
Moderate / Severe Substance Use Disorder, according to DSM V criteria (cf Substance Dependence Disorder according to ICD 10).
FVA & FVOD
These scales are face valid (direct reporting from the client themselves). Neither score is high enough to yield a high probability of Moderate/Severe SUD. Given the overall result, this would suggest that there is a degree of under-reporting here. Both scores in fact appear low; around the average for adolescents. The alcohol score suggests a slight preference for alcohol over other drugs, although this may reflect accessibility rather than preference. It is recommended that individual responses are examined, especially in the light of any other collateral information available. It may be helpful to use these responses as a stepping-off point for further linked questioning.
The Family and Friends Risk scale score (face valid) is above average, suggesting that family and / or friends provide a social environment in which substance use is facilitated. Again, it is recommended that individual responses are examined, as these will reveal further detail, e.g. whether friends or family are using themselves or encouraging or modelling use, or whether parents are merely providing little supervision of their children. Living within an environment where substance misuse is ubiquitous can lead to its “normalisation” in the mind of the individual, and this could account, at least to some extent, for the apparent under-reporting on the face valid scales.
Again, the ATT score (face valid) is above average, indicating that this young person holds a positive attitude towards substance use. (With some individuals, descent into severe addiction is reflected in a low ATT score. Where the ATT score is high, one could infer that dire consequences have not yet occurred). Clearly, if he believes that substance use offers an enhancement to his life experience in some way, he is not likely to be motivated to try to refrain from it. Examination of the individual responses may shed light on exactly what his attitudes are. However, it is not recommended that a young person with a high ATT score be confronted directly on the attitudes they hold, as this may provoke resistance which can be counter-productive, and further embed pre-existing beliefs. Ideally, a programme of peer education might offer a better way of changing the young person’s opinions.
The SYM score (face valid) is within the average range. This indicates that the young person is not acknowledging many symptoms or correlates of substance use. It may be useful to examine individual responses to see what symptoms or correlates the young person does identify, and to ensure that they understand the connection between them and the substance use. Because this score is face valid, it is manipulable, and it is possible that there is some deliberate under-reporting here.
The score here is average. This young person appears to be reluctant to acknowledge personality characteristics which are common in substance misusers, e.g. impatience, impulsivity, difficulty deferring gratification, grandiosity, resentment or self-pity. The suggestion is that he may not see himself as having a substance misuse issue, and it is potentially problematic, as he may be likely to resist hearing feedback from other people, if he perceives that feedback to be critical. He may not feel that he has much in common with people who have substance misuse issues, so he may not believe he can learn much from them, and he seems unlikely to benefit readily from group work at this time.
The SAT score is within the average range, indicating this young person is in touch with his feelings and has the capacity for self-analysis. This is clearly a positive sign, suggesting that he has the mental equipment to understand and work on his problems, and that he is capable of learning from emotional experiences. Praise can be given for this. If and when he is motivated to make changes, these characteristics will be important tools to help him fashion a successful outcome.
The DEF score is within the average range, although it is on the high side of average, indicating some degree of defensiveness. This could be a fixed personality characteristic, or it could be situational, e.g. reflecting the person’s uncertainty about the functions or consequences of the screening. It is possible that the apparent under-reporting on the FV scales might represent an attempt at concealment of the extent of the substance misuse. It is recommended that care be taken in initial approaches to express empathy, as the client may be anticipating criticism and may interpret neutral enquiry as hostile.
This is not relevant to the profiling exercise.
The COR score is within the average range, indicating that this young person appears no more likely than the average adolescent to have any serious involvement with the criminal justice system. If he is involved in offending behaviour, it may be useful to look at the nature of his offending, to see if it is perpetrated either under the influence, or in order to fund the habit. If this is so, and given his probable status (Moderate/Severe SUD, DSM V, or Substance Dependent, ICD 10 “difficulty controlling onset, termination or levels of use”), it would seem reasonable to suggest that the substance use could be driving the offending, and that its removal might, by and of itself, preclude further law-breaking.
This young man appears to have a high probability of substance dependence, although he is likely to be resistant to acknowledging this. Sometimes people do not realise they are dependent because they have never attempted any period of abstinence. The dependence may be recent and not entrenched, and may reflect neuro-adaptation rather than physical addiction. He may therefore not (yet) have experienced many negative consequences. His family or friends may be providing an unhelpful environment. His attitudes to substance misuse seem positive, and therefore he is unlikely to be motivated to change at this time. However, if his resistance were lowered and if he were motivated to re-evaluate the role of substance misuse in his life experience and chances, he would appear to have the psychological equipment to make a success of overcoming his substance use issues.
*1 Access to both the filled-out questionnaire and the scale scores would enable the interpreter to provide a more detailed analysis.
*2 This is a subtle score used statistically to help identify the presence or absence of a SUD. Interpretations of subtle scores derive from accumulated analyses of similar profiles. They should be regarded as hypotheses to assist in exploratory discussions with the client.