Adapting a Substance Abuse Screening Instrument SASSIVRASL for persons who are Deaf - PowerPoint PPT Presentation


Title: Adapting a Substance Abuse Screening Instrument SASSIVRASL for persons who are Deaf


1
Adapting a Substance Abuse Screening Instrument
(SASSI-VR-ASL) for persons who are Deaf
  • Debra Guthmann, Ed. D.

2
Introduction
  • Substance Abuse Screening/Assessments
  • To date there is no formal substance abuse
    assessment/screening instrument specifically
    normed to use with the Deaf population.
  • Statistics on the prevalence of substance abuse
    in the Deaf community assumes the occurrence is
    parallel to the hearing majority however valid
    estimates are limited.
  • Numerous factors can be attributed to this lack
    of data.
  • Barriers include the inaccessibility of
    screening assessments.

3
Alcohol ScreeningTo Detect Dependent Drinkers -
CAGE
  • Have people Annoyed you by criticizing your
    drinking?
  • Have you ever felt bad or Guilty about your
    drinking?
  • Have you ever had a drink first thing in the
    morning to steady your nerves or get rid of a
    hangover? (Eye opener)
  • Have you ever felt that you should Cut down on
    your drinking?

4
Additional Screening QuestionsRAFFT (Cherpital)
  • Relax- Use to relax?
  • Alone- Use alone?
  • Family- Use with family?
  • Friends- Use with friends?
  • Trouble- Had any problems related to alcohol use?

5
Additional Screening Questions Used to Predict
Risk
  • Family History
  • Has anyone in your family, such as your parents
    or siblings, had any problems with alcohol?
  • Do you think they drink too much?
  • Did their drinking affect you when you were
    growing up?

6
Additional Screening Questions Used to Predict
Risk
  • Age at first drink?
  • Age first time you became drunk?
  • How many times did you drink in high school?
  • How many times a week did you drink alcohol in
    high school?

7
Self Administered Pencil and Paper Questionnaire
  • Alcohol Use Disorder Inventory Test (AUDIT) (10
    questions)
  • 3 quantity/frequency questions
  • 3 CAGE questions
  • 4 consequence (blackouts, injuries, DUI,
    physician advice)

8
Alcohol Use Disorders Identification Test (AUDIT)
  • The following questions are about the past
    year. (Score)
  • 1. How often do you have a drink containing
    alcohol?
  • q Never (0) q Monthly or
    less (1) q 2 to 4 times a month (2)
    q 2 to 3 times a week (3) q 4 or more
    times a week (4)
  • __________________________________________________
    __________________________________
  • 2. How many drinks containing alcohol do you have
    on a typical day when you are drinking?
  • q None (0) q 1 or 2 (1) q 3 or 4
    (2)
  • q 5 or 6 (3) q 7 to 9 (4) q 10 or more (5)
  • __________________________________________________
    __________________________________
  • 3. How often do you have six or more drinks on
    one occasion?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)

9
Alcohol Use Disorders Identification Test (AUDIT)
  • 4. How often during the last year have you found
    that you were unable to stop drinking once you
    had started?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    _______________
  • 5. How often during the last year have you failed
    to do what was normally expected from you because
    of drinking?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    _________________________
  • 6. How often during the last year have you needed
    a first drink in the morning to get yourself
    going after a heavy drinking session?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)

10
Alcohol Use Disorders Identification Test (AUDIT)
  • 7. How often during the last year have you had a
    feeling of guilt or remorse after drinking?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    _________
  • 8. How often during the last year have you been
    unable to remember what happened the night before
    because you had been drinking?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    ___________
  • 9. Have you or someone else been injured as the
    result of your drinking?
  • q No (0) q Yes, but not in the last year
    (2) q Yes, during the last year (4)

11
Alcohol Use Disorders Identification Test (AUDIT)
  • __________________________________________________
    ____________
  • 10. Has a relative, friend, or a doctor or other
    health worker been concerned about your drinking
    or suggested you cut down?
  • q No (0) q Yes, but not in the last year
    (2) q Yes, during the last year (4)
  • A score of 8 or more is suggestive of high-risk
    drinking. People who score positive on the AUDIT
    should be assessed for potential alcohol-related
    problems.
  • Babor TF, de la Fuente JR, Saunders J, Grant M.
    AUDIT The Alcohol Use Disorders Identification
    Tests Guidelines for use in Primary Health Care.
    Geneva, Switzerland World Health Organization,
    1992.

12
Michigan Alcohol Screening Test (MAST)
  • Structured interview instrument consisting of 25
    questions
  • Administered rapidly
  • Devised to provide a consistent, quantifiable
    instrument for the detection of alcoholism.
  • The Brief Michigan Alcohol Screening Test (BMAST)
  • Shortened version of the MAST
  • 9 questions
  • Administered as a paper and pencil test or read
    out loud to the individual
  • Individual simply is required to respond with
    either yes or no to a series of questions
    designed to be significantly neutral I
  • Individuals reluctant to identify themselves as
    dependent or abusing alcohol may reveal their
    affliction (Fuller et al, 1994)
  • A score of five or more is considered compatible
    with substance abuse.

13
Michigan Alcohol Screening Test (MAST)Please
answer YES or NO to the following questions. (You
may substitute the words drug use in place of
drinking)
  • 1. Do you feel you are a normal drinker?
    ("normal" - drink as much or less than
  • most other people)
  • 2. Have you ever awakened the morning after some
    drinking the night before and found that you
    could not
  • remember a part of the evening?
  • 3. Does any near relative or close friend ever
    worry or complain about your drinking?
  • 4. Can you stop drinking without difficulty after
    one or two drinks?
  • 5. Do you ever feel guilty about your drinking?
  • 6. Have you ever attended a meeting of Alcoholics
    Anonymous (AA)?
  • 7. Have you ever gotten into physical fights when
    drinking?
  • 8. Has drinking ever created problems between you
    and a near relative or close friend?
  • 9. Has any family member or close friend gone to
    anyone for help about your drinking?
  • 10. Have you ever lost friends because of your
    drinking?

14
Michigan Alcohol Screening Test (MAST)Please
answer YES or NO to the following questions. (You
may substitute the words drug use in place of
drinking.)
  • 12. Have you ever lost a job because of drinking?
  • 13. Have you ever neglected your obligations,
    your family, or your work for two or more days in
    a row
  • because you were drinking?
  • 14. Do you drink before noon fairly often?
  • 15. Have you ever been told you have liver
    trouble such as cirrhosis?
  • 16. After heavy drinking have you ever had
    delirium tremens (D.T.'s), severe shaking, visual
    or auditory
  • (hearing) hallucinations?
  • 17. Have you ever gone to anyone for help about
    your drinking?
  • 18. Have you ever been hospitalized because of
    drinking?
  • 19. Has your drinking ever resulted in your being
    hospitalized in a psychiatric ward?
  • 20. Have you ever gone to any doctor, social
    worker, clergyman or mental health clinic for
    help with any
  • emotional problem in which drinking was part of
    the problem?

15
Michigan Alcohol Screening Test (MAST)Scoring
  • Score one point if you answered the following1.
    No2. Yes3. Yes4. No5. Yes6. Yes7 through
    22 Yes
  • Add up the scores and compare to the following
    score card0 - 2 No apparent problem3 - 5 Early
    or middle problem drinker6 or more Problem
    drinker

16
Adapting a Substance Abuse Screening Instrument
(SASSI-VR-ASL) for persons who are Deaf
  • The Research and Training Center on Disability
    and Vocational Rehabilitation at Wright State
    University is adapting the SASSI for consumers of
    VR with approximately 1,000 consumers in three
    states.
  • Due to issues related to readability, wording,
    regional signs, instrument length, it was
    determined that the SASSI-VR may not be effective
    with many Deaf individuals.
  • Additional funding was requested and received
    from The National Institute on Disability and
    Rehabilitation Research (NIDRR) to develop the
    SASSI-VR-ASL.

17
Substance Abuse Subtle Screening Inventory (SASSI)
  • Original version
  • 75 item, self-report instrument used to identify
    people with alcohol and/or drug problems
  • Design
  • 46 General statements true/false format
  • 12 Alcohol and 17 Drug questions required the
    respondent to indicate how often never, one or
    more times, repeatedly, they had experienced
    listed situations during the past 12 months.

18
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)General
  • Mark YES or NO for each question.
  • 1. Most people make some mistakes in their life.
  • 2. I have never been in trouble with the police.
  • 3. I was always well behaved in school.
  • 4. My troubles are not all my fault.
  • 5. I have not lived the way I should.
  • 6. I do not like to sit and daydream.
  • 7. No one has ever criticized or punished me.
  • 8. Sometimes I have a hard time sitting still.
  • 9. At times I feel worn out for no special
    reason.
  • 10. Sometimes Ive had days, weeks or months when
    I couldnt get much done because I just wasnt up
    to it.
  • 11. I am very respectful of people who are in
    charge of running things.
  • 12. I like to obey the law.
  • 13. I have been tempted to leave home for good.
  • 14. I often feel that strangers look at me as if
    they dont like me.
  • 15. Some criminals are so clever that I hope they
    get away with what they have done.
  • 16. I have sometimes drunk too much.
  • 17. Much of my life is boring.

19
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)
  • 18. Sometimes I wish I could control myself
    better.
  • 19. I believe that people sometimes get confused.
  • 20. I break more laws than many people.
  • 21. If some friends and I were in trouble
    together, I would rather take the whole blame
    than tell on them.
  • 22. I think there is something wrong with my
    memory.
  • 23. I have never broken a serious law.
  • 24. Nearly everyone enjoys being picked on and
    made fun of.
  • 25. There have been times when I have done things
    I couldnt remember later.
  • 26. I know who is to blame for most of my
    troubles.
  • 27. I have used too much alcohol or pot or used
    too often.
  • 28. I guess I know some people with pretty bad
    reputations.
  • 29. Most people will laugh at a joke now and
    then.
  • 30. I have hardly ever been punished.
  • 31. I smoke cigarettes regularly.
  • 32. At times I have been so full of energy that I
    felt I didnt need to sleep for days at a time.
  • 33. I often spend time thinking about people who
    have done me wrong

20
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)
  • 34. I have sometimes sat around when I should
    have been working.
  • 35. I take all my responsibilities seriously.
  • 36. I have neglected obligations to family or
    work because of my drinking or using drugs.
  • 37. I have had a drink first thing in the morning
    to steady my nerves or get rid of a hangover.
  • 38. While I was a teenager, I began drinking or
    using other drugs regularly.
  • 39. My father was/is a heavy drinker or drug
    user.
  • 40. When I drink or use drugs I tend to get into
    trouble.
  • 41. My drinking or other drug use causes problems
    between my family and me.
  • 42. I do most of my drinking or drug use away
    from home.
  • 43. My doctors have not prescribed enough
    medication to get the relief I need.
  • 44. At least once a week I use some
    over-the-counter medicines for stomach acid or
    digestion problems.
  • 45. I have never felt sad over anything.
  • 46. I have periods where I drink or use drugs a
    lot and then dont use at all for a while.

21
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)ALCOHOL
  • For each question mark 5 or more times, 1-4 times
    or never.
  • 1. In the past 12 months, I had drinks with
    lunch.
  • 2. In the past 12 months, I took a drink(s) to
    help express my feelings or ideas.
  • 3. In the past 12 months, I took a drink(s) to
    help me feel less tired or to give me energy to
    keep going.
  • 4. In the past 12 months, I had more to drink
    than I intended to.
  • 5. In the past 12 months, I experienced physical
    problems after drinking. (such as, nausea,
    seeing/hearing problems, dizziness, etc.)
  • 6. In the past 12 months, I got into trouble on
    the job, in school, or at home because of
    drinking.
  • 7. In the past 12 months, I became depressed
    after I sobered up.
  • 8. In the past 12 months, I argued with my
    family or friends because of my drinking.
  • 9. In the past 12 months, I had the effects of
    drinking happen again after I didnt drink for a
    while. (For example, flashbacks, seeing things
    that werent really there, etc.)
  • 10. In the past 12 months, I had problems in
    relationships because of my
  • drinking. (For example, loss of friends,
    separations, divorce, etc.)
  • 11. In the past 12 months, I became nervous or
    had the shakes after I sobered up.
  • 12. In the past 12 months, I tried to commit
    suicide while I was drunk.

22
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)Other Drugs
  • For each question mark 5 or more times, 1-4 times
    or never.
  • The word misuse means taking medicine in
    larger amounts than prescribed, longer than
    prescribed, or using someone elses medicines.
    Drugs include things like pot, cocaine, meth,
    heroin, etc.
  • 1. In the past 12 months, I misused medicines or
    took drugs to improve my thinking or feeling.
  • 2. In the past 12 months, I misused medicines or
    took drugs to feel better about a problem.
  • 3. In the past 12 months, I misused medicines or
    took drugs to become more aware of my senses.
    For example, sight, hearing, touch, etc.
  • 4. In the past 12 months, I misused medicines or
    took drugs to improve my enjoyment of sex.
  • 5. In the past 12 months, I misused medicines or
    took drugs to help me forget bad feelings I have
    about myself.
  • 6. In the past 12 months, I misused medicines
    or took drugs to forget school, work, or family
    pressures.
  • 7. In the past 12 months, I got into trouble
    with the law because of drugs.
  • 8. In the past 12 months, I got really stoned
    or wiped out on drugs - more than just high.

23
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)
  • 9. In the past 12 months, I tried to talk a
    doctor into giving me a prescription drug. (For
    example, tranquilizers, pain killers, pills to
    calm my nerves, etc.)
  • 10. In the past 12 months, I spent my spare time
    in drug-related activities. (For example,
    talking about drugs, buying, selling, taking,
    etc.)
  • 11. In the past 12 months, I drank alcohol and
    took medicines or drugs at the same time.
  • 12. In the past 12 months, I kept taking medicine
    or used drugs in order to avoid pain or
    withdrawal.
  • 13. In the past 12 months, I have felt that
    misuse of medicines or drug use has kept me from
    getting what I want out of life.
  • 14. In the past 12 months, I took a higher dose
    or different medicines than my doctor prescribed
    in order to get the relief I need.
  • 15. In the past 12 months, I used other peoples
    medication.
  • 16. In the past 12 months, my doctor denied my
    request for medication I needed.
  • 17. In the past 12 months, I was accepted into a
    treatment program due to misuse of medicines or
    drug use.

24
Substance Abuse Subtle Screening Inventory
(SASSI) Description of the subscales
  • Symptoms (SYM) reflecting symptoms of AOD use
    (e.g. I have sometimes drunk too much).
  • Obvious Attributes (OAT) measure the clients
    openness or willingness to admit symptoms or
    problems related to substance abuse. Those
    people with elevated scores may be able to
    recognize their resentments, feelings of
    self-pity, impulsivity and low frustration
    tolerance.
  • Subtle Attributes (SAT) An elevated SAT may
    indicate that the client is sincerely deluded
    or unaware of the says in which AOD have impacted
    his or her life. The client may also lack
    insight.

25
Substance Abuse Subtle Screening Inventory
(SASSI) Description of the subscales
  • Defensiveness (DEF) A high score on this
    subscale may reflect a test taking defensiveness
    or a deliberate attempt to manipulate the test.
    Therefore, a high score may be an attempt by a
    client to conceal a substance use disorder. Low
    scores may indicate feelings of worthlessness or
    difficulty in accepting positive feedback.
  • Supplemental Addiction Measure (SAM) used in
    conjunction with the DEF scale to differentiate
    the defensive responses of clients with a high
    probability of a substance dependence disorder
    from those clients with a low probability of such
    a disorder.
  • Family versus Controls (FAM)) identify clients
    who are members of a substance-abusing family
    system.

26
Substance Abuse Subtle Screening Inventory
(SASSI) Description of the subscales
  • Correctional (COR) measure of acting-out
    behavior. A high score matches the responses of
    individuals in correctional settings. If a
    person receives a high score, is not in a
    correctional setting, and is not classified as
    chemically dependent on the rest of the SASSI,
    the persons acting out may be attributed to
    causes other than alcohol or other drug abuse.
  • Random Answering Pattern (RAP) a validity scale
    to detect random responding, reading or
    comprehension problems, faking, or other problems
    that would cause a client to give highly unusual
    responses. The items are statements to which
    nearly everyone would give the same response
    (e.g., People always do the right thing).
  • Note As useful as the SASSI is, a self-report
    inventory should not be used in isolation from
    other assessment techniques, diagnosis should be
    made only by mental health providers with formal
    training and experience in the AOD field and
    should be based on a comprehensive assessment.

27
SASSI-VR-ASL Modifications
  • Translation into American Sign Language
  • Follows a yes/no format (instead of True/False)
  • A linguistics committee consisting of 5 Deaf
    individuals
  • met multiple times to review SASSI questions item
    by item and come to agreement about how to
    interpret each equivalent.
  • met in the studio for two sessions to create a
    CD-Rom ASL version of the SASSI modeled by a
    native Deaf signer.
  • Directions for each section were signed.
  • The concept of time, experiencing in the past 12
    months, was set as a marker
  • The term Drugs was clarified to include
    Misuse of prescription drugs and Use of
    drugs
  • Ambiguous terms were expanded (e.g. the shakes)
  • The Producer edited the CD-Rom and created an
    interactive version to be used for the back
    translation process.

28
Participants
AGE N 37 Ages ranged from 24 to 62 (mean of 43)
29
Participants
30
N37 REPORTING STATES/36 Unidentified/1
  • ARIZONA (AZ)
  • CALIFORNIA (CA)
  • COLORADO (CO)
  • GEORGIA (GA)
  • ILLINOIS (IL)
  • INDIANA (IN)
  • IOWA (IA)
  • KANSAS (KS)
  • KOREA
  • MARYLAND (MD)
  • MASSACHUSETTS (MA)
  • MINNESOTA (MN)
  • NEW JERSEY (NJ)
  • NEW YORK (NY)
  • OHIO (OH)
  • ONTARIO, CANADA
  • OREGON (OR)

31
Back Translation Procedure
  • Individuals sought nationally for participation
    in the process to ensure that sign selections
    were not regional
  • Participants were all Deaf or CODAs (Children of
    Deaf Adults).
  • They were given a copy of the CD-Rom with
    directions to review and write down each question
    in English (conceptually).
  • Subjects participated in the study blindly, they
    had not seen the original version of the
    instrument.
  • Some participants received a 25.00 stipend for
    their participation
  • Responses were collected and analyzed.

32
Back Translation Findings
  • 32 correctly completed responses were received.
  • The length of the instrument, (75 Questions),
    required some people several hours to complete
  • Results were analyzed by three raters
  • Equivalency between the original and translated
    version was evaluated
  • The author of the instrument at the SASSI
    Institute, and the Project Director from the RRTC
    at Wright State were also involved in this
    process comparing the data to their own studies
    used with VR (Vocational Rehabilitation)
    participants

33
Back Translation Findings
  • There are three sections to the SASSI
  • General- most clearly understood
  • Alcohol- confusion with the concept use in the
    past 12 months
  • Drug- confusion with the concept use in the past
    12 months and Misuse of prescription drugs
  • 5) Other misunderstandings and confusion
  • Never vs. Ever
  • Frequency of use (1-4 times/5 times or more)
  • Description of Symptoms (e.g., flashbacks,
    hallucinations)
  • Implication of judgment (disapproval)

34
Revision of Translated Tool
  • Recommendations were made for translations to be
    kept, revised or eliminated
  • 42 Questions were kept including some revisions
  • The Focus group met again to review the results
    from the back translation and made revisions
  • A second CD-Rom with the revisions was made

35
Next steps
  • Goal
  • Reduce number of questions to 20-25 in order to
    shorten the length of the assessment
  • Funding will be sought to do a large validation
    of the instrument for use within the Deaf
    community
  • Future Recommendations
  • Determine
  • Regional influences
  • Appropriateness for all language users

36
References
  • Alexander, T., DiNitto, D., Tidblom, I.
    Screening for Substance Abuse Problems Among the
    Deaf.
  • Brislin, R. (1970). Back-Translation for Cross
    Cultural Research. Journal of Cross-Cultural
    Psychology. 1, 185-216.
  • Crowe, T. (2002). Translation of the Rosenberg
    Self-Esteem Scale into American Sign Language A
    principal components analysis. Social Work
    Research, 26, 57-63.
  • Crowe Mason, T. (2005). CROSS-CULTURAL INSTRUMENT
    TRANSLATION ASSESSMENT, TRANSLATION, AND
    STATISTICAL APPLICATIONS. American Annals of the
    Deaf, 150, 67-72
  • Gallaudet Research Institute. 1996. Stanford
    Achievement Test, 9th Edition, Form S, Norms
    Booklet for Deaf and Hard-of-Hearing Students.
    Washington, DC Gallaudet University.
  • Gorski, R. (1980). Drug abuse and disabled
    people A Hidden problem. Disabled USA. 4(2),
    8-12.
  • Guthmann, D. , Sandberg, K. (1998) Assessing
    substance abuse problems in deaf and hard of
    hearing individuals. American Annals of the Deaf.
    14-21.
  • Guthmann, D
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    Outcomes Of Chemically Dependent Deaf And Hard of
    Hearing Individuals
  • Assessing Substance Abuse Problems with Deaf and
    Hard of Hearing Students
  • Barriers to Treatment and Recovery
  • Is There a Substance Abuse Problem Among Deaf and
    Hard of Hearing Individuals?
  • Providing Substance Abuse Treatment to Deaf and
    Hard of Hearing Clients
  • Substance Abuse and the Deaf/HH Community
  • Retrieved from http//www.mncddeaf.org/pages/arti
    cles.htm
  • Lipton, D. and Goldstein, M. (1997). Measuring
    Substance Abuse Among the Deaf. Journal of Drug
    Issues27, 733-754.
  • Moore, D. and L. Li (1994). "Substance abuse
    among applicants for vocational rehabilitation
    services." Journal of Rehabilitation 60(4)
    48-53.
  • Schwartz, N. S., Mebane, D. L, Malony H. N.
    (1990). Effects of alternate modes of
    administration on Rorschach performance of deaf
    adults. Journal of Personality Assessment, 54,
    671-83.
  • Steinberg, A. G., Lipton, D. S., Eckhardt, E. A.,
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    on interactive video A preliminary
    investigation. American Journal of Psychiatry,
    155, 1603-4.
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Title: Adapting a Substance Abuse Screening Instrument SASSIVRASL for persons who are Deaf


1
Adapting a Substance Abuse Screening Instrument
(SASSI-VR-ASL) for persons who are Deaf
  • Debra Guthmann, Ed. D.

2
Introduction
  • Substance Abuse Screening/Assessments
  • To date there is no formal substance abuse
    assessment/screening instrument specifically
    normed to use with the Deaf population.
  • Statistics on the prevalence of substance abuse
    in the Deaf community assumes the occurrence is
    parallel to the hearing majority however valid
    estimates are limited.
  • Numerous factors can be attributed to this lack
    of data.
  • Barriers include the inaccessibility of
    screening assessments.

3
Alcohol ScreeningTo Detect Dependent Drinkers -
CAGE
  • Have people Annoyed you by criticizing your
    drinking?
  • Have you ever felt bad or Guilty about your
    drinking?
  • Have you ever had a drink first thing in the
    morning to steady your nerves or get rid of a
    hangover? (Eye opener)
  • Have you ever felt that you should Cut down on
    your drinking?

4
Additional Screening QuestionsRAFFT (Cherpital)
  • Relax- Use to relax?
  • Alone- Use alone?
  • Family- Use with family?
  • Friends- Use with friends?
  • Trouble- Had any problems related to alcohol use?

5
Additional Screening Questions Used to Predict
Risk
  • Family History
  • Has anyone in your family, such as your parents
    or siblings, had any problems with alcohol?
  • Do you think they drink too much?
  • Did their drinking affect you when you were
    growing up?

6
Additional Screening Questions Used to Predict
Risk
  • Age at first drink?
  • Age first time you became drunk?
  • How many times did you drink in high school?
  • How many times a week did you drink alcohol in
    high school?

7
Self Administered Pencil and Paper Questionnaire
  • Alcohol Use Disorder Inventory Test (AUDIT) (10
    questions)
  • 3 quantity/frequency questions
  • 3 CAGE questions
  • 4 consequence (blackouts, injuries, DUI,
    physician advice)

8
Alcohol Use Disorders Identification Test (AUDIT)
  • The following questions are about the past
    year. (Score)
  • 1. How often do you have a drink containing
    alcohol?
  • q Never (0) q Monthly or
    less (1) q 2 to 4 times a month (2)
    q 2 to 3 times a week (3) q 4 or more
    times a week (4)
  • __________________________________________________
    __________________________________
  • 2. How many drinks containing alcohol do you have
    on a typical day when you are drinking?
  • q None (0) q 1 or 2 (1) q 3 or 4
    (2)
  • q 5 or 6 (3) q 7 to 9 (4) q 10 or more (5)
  • __________________________________________________
    __________________________________
  • 3. How often do you have six or more drinks on
    one occasion?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)

9
Alcohol Use Disorders Identification Test (AUDIT)
  • 4. How often during the last year have you found
    that you were unable to stop drinking once you
    had started?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    _______________
  • 5. How often during the last year have you failed
    to do what was normally expected from you because
    of drinking?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    _________________________
  • 6. How often during the last year have you needed
    a first drink in the morning to get yourself
    going after a heavy drinking session?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)

10
Alcohol Use Disorders Identification Test (AUDIT)
  • 7. How often during the last year have you had a
    feeling of guilt or remorse after drinking?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    _________
  • 8. How often during the last year have you been
    unable to remember what happened the night before
    because you had been drinking?
  • q Never (0) q Less than monthly (1) q
    Monthly (2)
  • q Weekly (3) q Daily or almost daily (4)
  • __________________________________________________
    ___________
  • 9. Have you or someone else been injured as the
    result of your drinking?
  • q No (0) q Yes, but not in the last year
    (2) q Yes, during the last year (4)

11
Alcohol Use Disorders Identification Test (AUDIT)
  • __________________________________________________
    ____________
  • 10. Has a relative, friend, or a doctor or other
    health worker been concerned about your drinking
    or suggested you cut down?
  • q No (0) q Yes, but not in the last year
    (2) q Yes, during the last year (4)
  • A score of 8 or more is suggestive of high-risk
    drinking. People who score positive on the AUDIT
    should be assessed for potential alcohol-related
    problems.
  • Babor TF, de la Fuente JR, Saunders J, Grant M.
    AUDIT The Alcohol Use Disorders Identification
    Tests Guidelines for use in Primary Health Care.
    Geneva, Switzerland World Health Organization,
    1992.

12
Michigan Alcohol Screening Test (MAST)
  • Structured interview instrument consisting of 25
    questions
  • Administered rapidly
  • Devised to provide a consistent, quantifiable
    instrument for the detection of alcoholism.
  • The Brief Michigan Alcohol Screening Test (BMAST)
  • Shortened version of the MAST
  • 9 questions
  • Administered as a paper and pencil test or read
    out loud to the individual
  • Individual simply is required to respond with
    either yes or no to a series of questions
    designed to be significantly neutral I
  • Individuals reluctant to identify themselves as
    dependent or abusing alcohol may reveal their
    affliction (Fuller et al, 1994)
  • A score of five or more is considered compatible
    with substance abuse.

13
Michigan Alcohol Screening Test (MAST)Please
answer YES or NO to the following questions. (You
may substitute the words drug use in place of
drinking)
  • 1. Do you feel you are a normal drinker?
    ("normal" - drink as much or less than
  • most other people)
  • 2. Have you ever awakened the morning after some
    drinking the night before and found that you
    could not
  • remember a part of the evening?
  • 3. Does any near relative or close friend ever
    worry or complain about your drinking?
  • 4. Can you stop drinking without difficulty after
    one or two drinks?
  • 5. Do you ever feel guilty about your drinking?
  • 6. Have you ever attended a meeting of Alcoholics
    Anonymous (AA)?
  • 7. Have you ever gotten into physical fights when
    drinking?
  • 8. Has drinking ever created problems between you
    and a near relative or close friend?
  • 9. Has any family member or close friend gone to
    anyone for help about your drinking?
  • 10. Have you ever lost friends because of your
    drinking?

14
Michigan Alcohol Screening Test (MAST)Please
answer YES or NO to the following questions. (You
may substitute the words drug use in place of
drinking.)
  • 12. Have you ever lost a job because of drinking?
  • 13. Have you ever neglected your obligations,
    your family, or your work for two or more days in
    a row
  • because you were drinking?
  • 14. Do you drink before noon fairly often?
  • 15. Have you ever been told you have liver
    trouble such as cirrhosis?
  • 16. After heavy drinking have you ever had
    delirium tremens (D.T.'s), severe shaking, visual
    or auditory
  • (hearing) hallucinations?
  • 17. Have you ever gone to anyone for help about
    your drinking?
  • 18. Have you ever been hospitalized because of
    drinking?
  • 19. Has your drinking ever resulted in your being
    hospitalized in a psychiatric ward?
  • 20. Have you ever gone to any doctor, social
    worker, clergyman or mental health clinic for
    help with any
  • emotional problem in which drinking was part of
    the problem?

15
Michigan Alcohol Screening Test (MAST)Scoring
  • Score one point if you answered the following1.
    No2. Yes3. Yes4. No5. Yes6. Yes7 through
    22 Yes
  • Add up the scores and compare to the following
    score card0 - 2 No apparent problem3 - 5 Early
    or middle problem drinker6 or more Problem
    drinker

16
Adapting a Substance Abuse Screening Instrument
(SASSI-VR-ASL) for persons who are Deaf
  • The Research and Training Center on Disability
    and Vocational Rehabilitation at Wright State
    University is adapting the SASSI for consumers of
    VR with approximately 1,000 consumers in three
    states.
  • Due to issues related to readability, wording,
    regional signs, instrument length, it was
    determined that the SASSI-VR may not be effective
    with many Deaf individuals.
  • Additional funding was requested and received
    from The National Institute on Disability and
    Rehabilitation Research (NIDRR) to develop the
    SASSI-VR-ASL.

17
Substance Abuse Subtle Screening Inventory (SASSI)
  • Original version
  • 75 item, self-report instrument used to identify
    people with alcohol and/or drug problems
  • Design
  • 46 General statements true/false format
  • 12 Alcohol and 17 Drug questions required the
    respondent to indicate how often never, one or
    more times, repeatedly, they had experienced
    listed situations during the past 12 months.

18
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)General
  • Mark YES or NO for each question.
  • 1. Most people make some mistakes in their life.
  • 2. I have never been in trouble with the police.
  • 3. I was always well behaved in school.
  • 4. My troubles are not all my fault.
  • 5. I have not lived the way I should.
  • 6. I do not like to sit and daydream.
  • 7. No one has ever criticized or punished me.
  • 8. Sometimes I have a hard time sitting still.
  • 9. At times I feel worn out for no special
    reason.
  • 10. Sometimes Ive had days, weeks or months when
    I couldnt get much done because I just wasnt up
    to it.
  • 11. I am very respectful of people who are in
    charge of running things.
  • 12. I like to obey the law.
  • 13. I have been tempted to leave home for good.
  • 14. I often feel that strangers look at me as if
    they dont like me.
  • 15. Some criminals are so clever that I hope they
    get away with what they have done.
  • 16. I have sometimes drunk too much.
  • 17. Much of my life is boring.

19
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)
  • 18. Sometimes I wish I could control myself
    better.
  • 19. I believe that people sometimes get confused.
  • 20. I break more laws than many people.
  • 21. If some friends and I were in trouble
    together, I would rather take the whole blame
    than tell on them.
  • 22. I think there is something wrong with my
    memory.
  • 23. I have never broken a serious law.
  • 24. Nearly everyone enjoys being picked on and
    made fun of.
  • 25. There have been times when I have done things
    I couldnt remember later.
  • 26. I know who is to blame for most of my
    troubles.
  • 27. I have used too much alcohol or pot or used
    too often.
  • 28. I guess I know some people with pretty bad
    reputations.
  • 29. Most people will laugh at a joke now and
    then.
  • 30. I have hardly ever been punished.
  • 31. I smoke cigarettes regularly.
  • 32. At times I have been so full of energy that I
    felt I didnt need to sleep for days at a time.
  • 33. I often spend time thinking about people who
    have done me wrong

20
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)
  • 34. I have sometimes sat around when I should
    have been working.
  • 35. I take all my responsibilities seriously.
  • 36. I have neglected obligations to family or
    work because of my drinking or using drugs.
  • 37. I have had a drink first thing in the morning
    to steady my nerves or get rid of a hangover.
  • 38. While I was a teenager, I began drinking or
    using other drugs regularly.
  • 39. My father was/is a heavy drinker or drug
    user.
  • 40. When I drink or use drugs I tend to get into
    trouble.
  • 41. My drinking or other drug use causes problems
    between my family and me.
  • 42. I do most of my drinking or drug use away
    from home.
  • 43. My doctors have not prescribed enough
    medication to get the relief I need.
  • 44. At least once a week I use some
    over-the-counter medicines for stomach acid or
    digestion problems.
  • 45. I have never felt sad over anything.
  • 46. I have periods where I drink or use drugs a
    lot and then dont use at all for a while.

21
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)ALCOHOL
  • For each question mark 5 or more times, 1-4 times
    or never.
  • 1. In the past 12 months, I had drinks with
    lunch.
  • 2. In the past 12 months, I took a drink(s) to
    help express my feelings or ideas.
  • 3. In the past 12 months, I took a drink(s) to
    help me feel less tired or to give me energy to
    keep going.
  • 4. In the past 12 months, I had more to drink
    than I intended to.
  • 5. In the past 12 months, I experienced physical
    problems after drinking. (such as, nausea,
    seeing/hearing problems, dizziness, etc.)
  • 6. In the past 12 months, I got into trouble on
    the job, in school, or at home because of
    drinking.
  • 7. In the past 12 months, I became depressed
    after I sobered up.
  • 8. In the past 12 months, I argued with my
    family or friends because of my drinking.
  • 9. In the past 12 months, I had the effects of
    drinking happen again after I didnt drink for a
    while. (For example, flashbacks, seeing things
    that werent really there, etc.)
  • 10. In the past 12 months, I had problems in
    relationships because of my
  • drinking. (For example, loss of friends,
    separations, divorce, etc.)
  • 11. In the past 12 months, I became nervous or
    had the shakes after I sobered up.
  • 12. In the past 12 months, I tried to commit
    suicide while I was drunk.

22
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)Other Drugs
  • For each question mark 5 or more times, 1-4 times
    or never.
  • The word misuse means taking medicine in
    larger amounts than prescribed, longer than
    prescribed, or using someone elses medicines.
    Drugs include things like pot, cocaine, meth,
    heroin, etc.
  • 1. In the past 12 months, I misused medicines or
    took drugs to improve my thinking or feeling.
  • 2. In the past 12 months, I misused medicines or
    took drugs to feel better about a problem.
  • 3. In the past 12 months, I misused medicines or
    took drugs to become more aware of my senses.
    For example, sight, hearing, touch, etc.
  • 4. In the past 12 months, I misused medicines or
    took drugs to improve my enjoyment of sex.
  • 5. In the past 12 months, I misused medicines or
    took drugs to help me forget bad feelings I have
    about myself.
  • 6. In the past 12 months, I misused medicines
    or took drugs to forget school, work, or family
    pressures.
  • 7. In the past 12 months, I got into trouble
    with the law because of drugs.
  • 8. In the past 12 months, I got really stoned
    or wiped out on drugs - more than just high.

23
Substance Abuse Subtle Screening Inventory
Vocational Rehabilitation (SASSI VR)
  • 9. In the past 12 months, I tried to talk a
    doctor into giving me a prescription drug. (For
    example, tranquilizers, pain killers, pills to
    calm my nerves, etc.)
  • 10. In the past 12 months, I spent my spare time
    in drug-related activities. (For example,
    talking about drugs, buying, selling, taking,
    etc.)
  • 11. In the past 12 months, I drank alcohol and
    took medicines or drugs at the same time.
  • 12. In the past 12 months, I kept taking medicine
    or used drugs in order to avoid pain or
    withdrawal.
  • 13. In the past 12 months, I have felt that
    misuse of medicines or drug use has kept me from
    getting what I want out of life.
  • 14. In the past 12 months, I took a higher dose
    or different medicines than my doctor prescribed
    in order to get the relief I need.
  • 15. In the past 12 months, I used other peoples
    medication.
  • 16. In the past 12 months, my doctor denied my
    request for medication I needed.
  • 17. In the past 12 months, I was accepted into a
    treatment program due to misuse of medicines or
    drug use.

24
Substance Abuse Subtle Screening Inventory
(SASSI) Description of the subscales
  • Symptoms (SYM) reflecting symptoms of AOD use
    (e.g. I have sometimes drunk too much).
  • Obvious Attributes (OAT) measure the clients
    openness or willingness to admit symptoms or
    problems related to substance abuse. Those
    people with elevated scores may be able to
    recognize their resentments, feelings of
    self-pity, impulsivity and low frustration
    tolerance.
  • Subtle Attributes (SAT) An elevated SAT may
    indicate that the client is sincerely deluded
    or unaware of the says in which AOD have impacted
    his or her life. The client may also lack
    insight.

25
Substance Abuse Subtle Screening Inventory
(SASSI) Description of the subscales
  • Defensiveness (DEF) A high score on this
    subscale may reflect a test taking defensiveness
    or a deliberate attempt to manipulate the test.
    Therefore, a high score may be an attempt by a
    client to conceal a substance use disorder. Low
    scores may indicate feelings of worthlessness or
    difficulty in accepting positive feedback.
  • Supplemental Addiction Measure (SAM) used in
    conjunction with the DEF scale to differentiate
    the defensive responses of clients with a high
    probability of a substance dependence disorder
    from those clients with a low probability of such
    a disorder.
  • Family versus Controls (FAM)) identify clients
    who are members of a substance-abusing family
    system.

26
Substance Abuse Subtle Screening Inventory
(SASSI) Description of the subscales
  • Correctional (COR) measure of acting-out
    behavior. A high score matches the responses of
    individuals in correctional settings. If a
    person receives a high score, is not in a
    correctional setting, and is not classified as
    chemically dependent on the rest of the SASSI,
    the persons acting out may be attributed to
    causes other than alcohol or other drug abuse.
  • Random Answering Pattern (RAP) a validity scale
    to detect random responding, reading or
    comprehension problems, faking, or other problems
    that would cause a client to give highly unusual
    responses. The items are statements to which
    nearly everyone would give the same response
    (e.g., People always do the right thing).
  • Note As useful as the SASSI is, a self-report
    inventory should not be used in isolation from
    other assessment techniques, diagnosis should be
    made only by mental health providers with formal
    training and experience in the AOD field and
    should be based on a comprehensive assessment.

27
SASSI-VR-ASL Modifications
  • Translation into American Sign Language
  • Follows a yes/no format (instead of True/False)
  • A linguistics committee consisting of 5 Deaf
    individuals
  • met multiple times to review SASSI questions item
    by item and come to agreement about how to
    interpret each equivalent.
  • met in the studio for two sessions to create a
    CD-Rom ASL version of the SASSI modeled by a
    native Deaf signer.
  • Directions for each section were signed.
  • The concept of time, experiencing in the past 12
    months, was set as a marker
  • The term Drugs was clarified to include
    Misuse of prescription drugs and Use of
    drugs
  • Ambiguous terms were expanded (e.g. the shakes)
  • The Producer edited the CD-Rom and created an
    interactive version to be used for the back
    translation process.

28
Participants
AGE N 37 Ages ranged from 24 to 62 (mean of 43)
29
Participants
30
N37 REPORTING STATES/36 Unidentified/1
  • ARIZONA (AZ)
  • CALIFORNIA (CA)
  • COLORADO (CO)
  • GEORGIA (GA)
  • ILLINOIS (IL)
  • INDIANA (IN)
  • IOWA (IA)
  • KANSAS (KS)
  • KOREA
  • MARYLAND (MD)
  • MASSACHUSETTS (MA)
  • MINNESOTA (MN)
  • NEW JERSEY (NJ)
  • NEW YORK (NY)
  • OHIO (OH)
  • ONTARIO, CANADA
  • OREGON (OR)

31
Back Translation Procedure
  • Individuals sought nationally for participation
    in the process to ensure that sign selections
    were not regional
  • Participants were all Deaf or CODAs (Children of
    Deaf Adults).
  • They were given a copy of the CD-Rom with
    directions to review and write down each question
    in English (conceptually).
  • Subjects participated in the study blindly, they
    had not seen the original version of the
    instrument.
  • Some participants received a 25.00 stipend for
    their participation
  • Responses were collected and analyzed.

32
Back Translation Findings
  • 32 correctly completed responses were received.
  • The length of the instrument, (75 Questions),
    required some people several hours to complete
  • Results were analyzed by three raters
  • Equivalency between the original and translated
    version was evaluated
  • The author of the instrument at the SASSI
    Institute, and the Project Director from the RRTC
    at Wright State were also involved in this
    process comparing the data to their own studies
    used with VR (Vocational Rehabilitation)
    participants

33
Back Translation Findings
  • There are three sections to the SASSI
  • General- most clearly understood
  • Alcohol- confusion with the concept use in the
    past 12 months
  • Drug- confusion with the concept use in the past
    12 months and Misuse of prescription drugs
  • 5) Other misunderstandings and confusion
  • Never vs. Ever
  • Frequency of use (1-4 times/5 times or more)
  • Description of Symptoms (e.g., flashbacks,
    hallucinations)
  • Implication of judgment (disapproval)

34
Revision of Translated Tool
  • Recommendations were made for translations to be
    kept, revised or eliminated
  • 42 Questions were kept including some revisions
  • The Focus group met again to review the results
    from the back translation and made revisions
  • A second CD-Rom with the revisions was made

35
Next steps
  • Goal
  • Reduce number of questions to 20-25 in order to
    shorten the length of the assessment
  • Funding will be sought to do a large validation
    of the instrument for use within the Deaf
    community
  • Future Recommendations
  • Determine
  • Regional influences
  • Appropriateness for all language users

36
References
  • Alexander, T., DiNitto, D., Tidblom, I.
    Screening for Substance Abuse Problems Among the
    Deaf.
  • Brislin, R. (1970). Back-Translation for Cross
    Cultural Research. Journal of Cross-Cultural
    Psychology. 1, 185-216.
  • Crowe, T. (2002). Translation of the Rosenberg
    Self-Esteem Scale into American Sign Language A
    principal components analysis. Social Work
    Research, 26, 57-63.
  • Crowe Mason, T. (2005). CROSS-CULTURAL INSTRUMENT
    TRANSLATION ASSESSMENT, TRANSLATION, AND
    STATISTICAL APPLICATIONS. American Annals of the
    Deaf, 150, 67-72
  • Gallaudet Research Institute. 1996. Stanford
    Achievement Test, 9th Edition, Form S, Norms
    Booklet for Deaf and Hard-of-Hearing Students.
    Washington, DC Gallaudet University.
  • Gorski, R. (1980). Drug abuse and disabled
    people A Hidden problem. Disabled USA. 4(2),
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  • Guthmann, D. , Sandberg, K. (1998) Assessing
    substance abuse problems in deaf and hard of
    hearing individuals. American Annals of the Deaf.
    14-21.
  • Guthmann, D
  • An Analysis of Variables That Impact Treatment
    Outcomes Of Chemically Dependent Deaf And Hard of
    Hearing Individuals
  • Assessing Substance Abuse Problems with Deaf and
    Hard of Hearing Students
  • Barriers to Treatment and Recovery
  • Is There a Substance Abuse Problem Among Deaf and
    Hard of Hearing Individuals?
  • Providing Substance Abuse Treatment to Deaf and
    Hard of Hearing Clients
  • Substance Abuse and the Deaf/HH Community
  • Retrieved from http//www.mncddeaf.org/pages/arti
    cles.htm
  • Lipton, D. and Goldstein, M. (1997). Measuring
    Substance Abuse Among the Deaf. Journal of Drug
    Issues27, 733-754.
  • Moore, D. and L. Li (1994). "Substance abuse
    among applicants for vocational rehabilitation
    services." Journal of Rehabilitation 60(4)
    48-53.
  • Schwartz, N. S., Mebane, D. L, Malony H. N.
    (1990). Effects of alternate modes of
    administration on Rorschach performance of deaf
    adults. Journal of Personality Assessment, 54,
    671-83.
  • Steinberg, A. G., Lipton, D. S., Eckhardt, E. A.,
    Goldstein, M., Sullivan, V. J. (1998). The
    Diagnostic Interview Schedule for deaf patients
    on interactive video A preliminary
    investigation. American Journal of Psychiatry,
    155, 1603-4.
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