SASSI ANALYSIS AND PROFILING
As with all interpretation and psychological profiling, the picture that emerges from the subtle scales of the SASSI must be regarded as a working hypothesis, and not as a representation of absolute reality. The aim is to engage the client in a cooperative process of exploration and assessment, and to assist a discussion of emerging patterns and issues. Feeding back the results to clients in a way that is supportive and motivating is a key feature of the SASSI training.
30 year old male – SASSI 4
Summary
This client appears to have a high probability of having a Substance Use Disorder according to the DSM V criteria. His very low DEF score gives rise to concerns about suicidal ideation, and it is recommended that this matter be addressed as a priority. If he has symptoms of physical dependency, and has recently been consuming large amount of psychoactive substances, he may need detoxification before he can begin to address the psychological and practical correlates of his substance use.
FVA & FVOD
These scores relate to the client’s answers to direct and open questions about substance use. This person’s “other drugs” score (FVOD) is high enough to classify him as having a SUD without any corroborative evidence. His alcohol score (FVA) is also very high, but not quite high enough to classify him. Thus it appears that he prefers illicit substances to alcohol, but his alcohol use is also significant. If there is evidence of dependency, there would be a risk of transference of dependency, should he attempt to abstain from other drug use. The client appears to have answered honestly and openly, and this deserves appreciation. It is highly recommended that individual responses are read and digested, as these will reveal useful information about motives for using, consequences and problems arising, and the client’s feelings about some of these issues. As all of these responses are face valid, they can be used as hooks to encourage further discussion, by dint of asking narrative questions, e.g. “tell me more about the problems you have had in relationships because of your drinking…” etc. Motivational Interviewing techniques can be useful here. If endorsed, FVA 12 (regarding suicide attempts when under the influence) is also an important warning.
SYM
Again, this is a face valid scale, so responses may yield useful information and can be discussed with the client. The score is very high here – above the 98th percentile, suggesting that the client is acknowledging many symptoms and correlates of substance misuse. There may be room for some educational work here, so, for example, the client may say they think there is something wrong with their memory, but they may not know that this can be caused by substance misuse. Given the very high face valid illicit drugs scores, it will be important to question the client about symptoms of physical dependency.
OAT
This is a subtle scale, so individual responses should not be examined or interrogated. The score is average, suggesting the client does not tend to see himself as sharing common personality characteristics with other substance users (e.g. impatience, impulsivity, difficulty deferring gratification, resentment, grandiosity and self-pity). Therefore he may not identify readily with other substance users, and may not feel that group work is likely to benefit him.
SAT
Again a subtle scale, and again, an average score. This suggests a well-adjusted outlook; the client is clearly able to “look his substance use in the eye”, and has an average amount of insight into the causes and origins of his behaviour. He appears to be in touch with his feelings, and is likely to be capable of rational self-analysis. He appears to have the tools he needs to address the problems he is facing.
DEF
The defensiveness scale is a subtle scale, so again, no interrogation of individual responses is appropriate. The score here is extremely low, indicating that the client is very depressed, may be lacking in energy, have very low self-esteem and low self-efficacy. With a score as low as this, test instructions routinely recommend an enquiry about suicidal ideation. As with all extreme scores, the question arises of how someone has come to exhibit such a presentation. Were they severely bullied at school, or were they victims of physical/emotional/sexual abuse? Whatever the origin, this sensitive issue needs to be addressed as a priority, not only in terms of ensuring client safety, but also in order to facilitate “recovery”. A client with such low self-esteem and feelings of self-efficacy is unlikely to be able to face tackling a problem they may see as insurmountable.
In some cases, a combination of high FV scores (i.e. FVA, FVOD & SYM) with a low DEF, may be symptomatic of a “rock bottom” presentation, where the client has just realised the extent of their substance use and the problems it has been causing, and that is making them feel really guilty and depressed.
SAM is not interpreted.
FAM
The low score here suggests that the client is not currently engaging well with other people. He may feel detached from social relationships and may indeed only interact with others when he sees it as furthering his own interests. (What one of my old colleagues used to term “a heroin addict with nothing left but a blanket” – i.e. he will talk to you if he thinks you might get him a fix). Hence, if the presentation is circumstantial, this score may return to the mean if and when the client is free of substance use. However, it can be symptomatic of a more ingrained difficulty in relating to others.
Rx 1 & 2
These scales reveal no misuse of prescribed medication.
COR
This is a high score, suggesting the client shares psychological characteristics with people who have a heavy involvement with the criminal justice system. It cannot be used in any crude way to predict the future, in terms of propensity to offend, or to commit particular offences. However, when drawing up an intervention plan, it may be helpful to consider what tends to put people at risk for offending, ( poor literacy, inconsistent punishment/reward systems in childhood, economic deprivation, lack of respect for authority, lack of empathy, etc), and to try to address any such issues that are apparent. It may be worth looking at any offending to see if it may be substance-related (i.e. in order to fund the habit or committed under the influence), but the implication of a high COR score is that addressing the substance misuse per se may not be sufficient intervention to preclude further offending.
RAP
The Random Answering Pattern score shows no indication of invalid reporting.
SASSI A3 Analysis – Adolescent Female, 17 years
Summary
This client’s SASSI scores yield a classification of Substance Use Disorder (DSM V), which is more likely to be Mild /Moderate SUD, than Severe SUD, i.e. more likely to be in the category of “Abuse” than “Dependence” (DSM IV). According to her own report, she appears to have a decided preference for alcohol, and to have little experience with illicit substances. Her psychological profile appears to be well balanced, which augurs well for intervention, although she may not be motivated to change at this time. Intervention with this client may be timely, and may halt a progression into alcohol dependency.
FVA & FVOD
The face valid FVA score is just high enough to classify this young person as having a SUD (DSM V). This classification derives from her own self-report, and indicates openness and lack of defensiveness. The FVOD score is extremely low, only one question attracting a frequency of “once or twice”. Again, it will be interesting to examine that response, and to use any of these face valid responses to initiate further conversations around her experiences.
FRISK
The score here is absolutely average, suggesting that the home and /or peer environment in which this young person moves is not likely to be particularly conducive to, or encouraging of substance use. This scale is also face valid, so individual responses may be read to give a fuller picture, and to initiate further discussion.
ATT
The score here is within the average range, although slightly on the high side of it. It tends to indicate that this young person has a fairly positive attitude to substance use, possibly because she may not yet have experienced many negative consequences of drinking. She seems, therefore, unlikely to be very motivated to cut down on her drinking at this time, but given that highly positive attitudes do not seem to be embedded, she may be open to attitudinal change through education, especially peer education. Direct confrontation regarding her attitudes is not recommended, as it may provoke resistance, although reading the responses may be instructive.
SYM
This is the only score within the psychological profiling that falls outside the average range. Sitting on the 85th percentile, it suggests that the client is exhibiting a number of symptoms of substance use. The SYM is face valid, so individual responses should be read to give a fuller picture. It is worth bearing in mind that although the client may be able to acknowledge symptoms of substance use, she may not realise the causal association. She may, for example, state that she thinks there is something wrong with her memory, but she may not realise that alcohol can be instrumental in destroying Vitamin B1 Thiamine in the body, which is essential for the brain’s proper functioning. There may be some scope for information / education here.
OAT
The OAT score is on the high side of average. It suggests that the client may acknowledge some of the personality traits which are common in substance users, e.g. impatience, impulsivity, difficulty deferring gratification, resentment, grandiosity and self-pity. Her ability to own negative characteristics of this type indicates a degree of maturity and openness to self-examination, which may be helpful in terms of “treatment readiness”. She may also readily identify with other young people with substance use issues and may therefore benefit from group work with peers. Possible downsides are that she may claim that traits like impatience may actually benefit her, and she may express an unwillingness to address them for this reason. Or she may believe that the negative characteristics are fixed and that there is nothing she can do to change them. If this is the case, it will be necessary to challenge these beliefs in a supportive way, through education and / or peer experience.
SAT
The SAT score is average, indicating the client has a good level of insight into the motivations of her own behaviour, and that she is likely to be quite good at self-analysis. She appears to be aware of the role of drinking in her life and is likely to be willing to discuss it. All in all, this score is very positive.
DEF
Again, this is average, i.e. well-balanced, indicating a lack of defensiveness coupled with a healthy level of self-esteem and self-efficacy. These qualities will be very helpful when s he decides to address her excess drinking.
SAM
This is within the average range and is not interpreted.
COR
The COR score is within the average range, suggesting this young person has little in common, psychologically, with other young people who are involved with the criminal justice system. If she has been involved in offending behaviours, it may be useful to see if substance use was implicated in the incidents, either as a disinhibitor or with a view to obtaining the substance or financing its acquisition. If this is the case, it may be argued that the substance use has a major role in is driving the offending, and that its removal may, by and of itself militate against further criminality.
Prescription Drug Scale
This indicates there is no misuse of prescribed medications.