Purpose of Assignment
The purpose of this assignment is to evaluate the results of a SASSI Report for a 38-year-old male by the name of Jim (The SASSI Institute, 2008). Jim has been referred to a therapist for a substance abuse evaluation after an arrest for domestic violence (The SASSI Institute, 2008). Since Jim isn’t here of his own volition, the therapist utilizes a the Substance Abuse Subtle Screening Inventory “SASSI-3”. Substance abuse consists of a failure to fulfill major role obligations, while alcohol dependence refers to symptoms of withdrawal and increased tolerance (Hays, 2013, p143). Miller, et al, (2001) describe substance abuse as an especially “cunning” (p3) disorder that can often dominate someone’s life, yet remain unnoticed. The SASSI-3 is useful in Jim’s case, since it can detect substance abuse even in individuals who likely to deny having a problem (Hays, 2013; Miller, et al, 2001). In the next section, I will briefly review the results of Jim’s SASSI report.
Collateral information indicates that this isn’t Jim’s first arrest for domestic violence (The SASSI Institute, 2008). Additionally, not only does Jim have an extensive history of substance use, his mother is an alcoholic as well. (The SASSI Institute, 2008).
FVA & FVOD SCORES
The SASSI-3 contains 26 direct questions that clients respond to utilizing a Likert-type scale (Miller, et al, 2001). Responses indicate how often individuals have experienced a some “specified event” in their lifetime (Blackwell & Toriello, 2005). Collectively these events indicate not only the presence of substance misuse, but a client’s willingness to acknowledge their problem. The “Face Valid Alcohol” (FVA) score is comprised of 12 items about an individual’s past alcohol use experiences (Miller, et al, 2001). The “Face Valid Other Drug” (FVOD) score is comprised of 14 items and asks about an individual’s past drug use history (Miller, et al, 2001). Jim FVA & FVOD scores are quite low, indicating that he doesn’t acknowledge a substance use history (The SASSI Institute, 2008).
Measures of Defensiveness
The “Defensiveness Score” (DEF) is a measure of an individual’s willingness to acknowledge a substance abuse problem. Individuals with high DEF scores are often said to be “Faking good” (Miller, et al, 2001), and often reflects an attempt to conceal evidence of a problem. T scores greater than 40 indicate the presence of defensiveness (The SASSI Institute, 2015). Interestingly, Jim’s score is 70, well above this cut-off point. This score indicates he is unwilling to acknowledge a problem and that therapists should proceed with caution when providing feedback on test scores (The SASSI Institute, 2015; Miller, et al, 2001) Feedback entails walking a fine line between confrontation and enabling, where an individual can be begin to information provided (Miller, et al, 2001). Avoid judging and labeling such clients in order to work at building an alliance. Since these individuals tend to be highly resistant to change, assist them in acknowledging its value is a primary therapeutic goal (Hays, 2013; Miller, et al, 2001)
Family History Measures
SYM Score. Two family history measures can be found in Jim’s SASSI results and are useful in contextualizing scores all discussed thus far. The Symptom Score (SYM) assesses the correlates and causes of substance abuse (Blackwell & Torelli, 2005). Miller, et al, (2001) state it is useful in determining if individuals are part of a social system that focuses strongly on alcohol (p2). Jim’s score is well below the T-Score of 7, and indicates he acknowledges no family history of substance abuse (Miller, et al, 2001).
FAM Score. The Family Versus Control Subjects Scale (FAM) indicates a response patterns that are similar to those with family members who uses substances (Miller, et al, 2001). Individuals with a high FAM score display a high degree of focus on others for one’s own well being (Miller, et al, 2001). This other-focused tendency frequently results in a high need of control, inability to trust, and inability to maintain healthy boundaries. While Jim’s SYM score indicates he does not acknowledge a family history of substance abuse, his high FAM score contradicts this. High FAM scores are indicative of a sense of worth and happiness that are focused on others (Miller, et al 2001). These traits appear to correlate with his domestic abuse history (The SASSI Institute, 2008). The contradiction between his FAM and SYN Scores indicate a low level of insight into this history (Miller, et al, 2001).
Obvious Attributes Score (OAT)
OAT scores indicate an ability to acknowledge traits commonly associated with substance abuser such as impulsiveness, self-pity, and low frustration tolerance (Miller, et al, 2001). In this respect, the OAT score is a measure of an individual’s level of insight. Jim’s OAT score is a 2, which places him in the 15th percentile (The SASSI Institute, 2008). Low OAT scores such as this indicate a low level of insight and high degree of denial (Miller, et al, 2001).
Overall Jim’s scores provide a series of conflictions. While Jim’s FVA and FVOD scores indicate low probability of substance use his DEF Scores indicate an unwillingness to admit to a problem. Additionally, while his SYM score indicates he does not acknowledge a family history of substance use, his FAM score prove otherwise. Finally, Jim’s OAT score indicates a low level of insight. When viewing this information alongside collateral reports, a therapist should be suspicious of the accuracy of his the information he provides. Whether or not test result conflicts are the result of low insight or intentional denial remains to be seen. Further assessments are required determine the presence of a substance abuse disorder.
Substance Abuse Assessments
If a substance abuse disorder does indeed exist, the class handout suggests toxicology screens and a no-use-contract (The SASSI Institute, 2008). Further assessments into his substance abuse history can start with a motivational interview. This tool is useful with individuals who are highly resistant to change and is helpful in building an alliance with Jim in moving forward (Hays, 2013). A review of information in the SASSI Report can be a jumping of point for further discussion in this respect. In order to do so, it will be important to assess the degree of discrepancy between Jim’s perceptions and reality. The ultimate goal in this case, would be to help Jim to develop a greater awareness and insight.
Abuse History & Intimate Partner Violence
The class handout suggests referring to a practitioner that treats perpetrators of domestic violence (The SASSI Institute, 2008). Assessments into Jim’s recent history of interpersonal violence are problematic at best. I would surmise that they might reflect deeply ingrained habits, he developed from his own childhood (The SASSI Institute, 2008). A family genogram would be helpful in outlining Jim’s own abuse history, and allow him to explore the effects it has had on him (Hays, 2013). A therapy group can be helpful in allowing Jim to begin acknowledging these issues (Hays, 2013)