Substance Abuse Questionnaire - Scale Descriptions

Substance Abuse Questionnaire
SCALES

The Substance Abuse Questionnaire (SAQ) filters individuals with serious substance (alcohol and other drugs) abuse and - related problems that may require intervention, counseling or treatment. This filtering system works as follows:

SAQ SCALE RISK RANGES
Risk Category	Risk Range Percentiles	Total Percentages
Low Risk	0 - 39%	39%
Medium Risk	40 - 69%	30%
Problem Risk	70 - 89%	20%
Severe Problem	90 - 100%	11%

Reference to the above table shows that a problem is not identified until a scale score is at or above the 70th percentile. This procedure is fair and avoids extremes, i.e., over-identification and under-identification of problems. There are several levels of SAQ interpretation ranging from viewing the SAQ as a self-report to interpreting scale evaluations and scale interrelationships.

SCALE INTERPRETATION

1. Truthfulness Scale: measures how truthful the client was while completing the Substance Abuse Questionnaire (SAQ). It identifies guarded and defensive people who attempt to minimize their problem and "look good". Truthfulness scale scores at or below the 89th percentile mean that all SAQ scale scores are accurate. When an SAQ Truthfulness Scale score is in the 70 to 89th percentile range, other SAQ scale scores are accurate because they have been Truth-Corrected. Truthfulness Scale scores in the zero to 69th percentile range mean all SAQ scale scores are accurate. In contrast, when the Truthfulness Scale score is at or above the 90th percentile, this means that all SAQ scales are innaccurate (invalid) because the client was overly guarded, in denial, attempting to minimize problems, or was attempting to "fake good". If not consciously deceptive, clients with elevated (70th percentile and higher) Truthfulness Scale scores are often uncooperative (likely in a passive aggressive manner), fail to understand directions and/or test items or have a need to appear in a good light. One of the first things to check when reviewing an SAQ report is the Truthfulness Scale score. Elevated Truthfulness Scale scores effect all other SAQ scale scores. A general rule of thumb is the higher the Truthfulness Scale score the more the client is attempting to deny or minimize substance-related problems. Note: Truthfulness Scale scores at or below the 89th percentile mean that all SAQ scale scores are accurate.

2. Alcohol Scale: measures alcohol use and the severity of abuse. Alcohol refers to beer, wine and other liquors. An elevated (70th to 89th percentile) Alcohol Scale is indicative of an emerging drinking problem. An Alcohol Scale score in the severe problem (90 to 100th percentile) range identifies established and serious drinking problems. Elevated Alcohol Scale scores do not occur by chance.

A history of alcohol problems (e.g., alcohol related arrests, DUI/DWI convictions, etc) could result in abstainer (current non-drinker) attaining a low to medium risk scale score. Consequently, safeguards have been built into the SAQ to identify "recovering alcoholics". For example, the clients self-reported court and alcohol history is summarized on the first page of the SAQ report. And the client's answer to the "recovering question" (#152) is printed in the significant items section of the SAQ report. The client's answer to the recovery alcoholic question is printed in the SAQ report to protect against misclassifying a recovering alcoholic. In addition, elevated Alcohol Scale paragraphs caution staff to establish if the client is a recovering alcoholic. If recovering, for how long?

Co-elevated Alcohol and Drugs Scale scores, especially if in the severe problem (90 to 100th percentile) range indicate polysubstance abuse and the highest score usually identifies the clients substance of choice. Scores in the severe problem (90 to 100th percentile) range are a malignant prognostic sign. An elevated Alcohol Scale score, particularly in the severe problem range, can exacerbate or magnify Aggressiveness Scale, Resistance Scale, and Drugs Scales scores. Excessive alcohol use can contribute to impaired stress management skills. Here you have a person with marginal stress management skills who drinks excessively resulting in even more impaired stress management.

In intervention and treatment settings, the client's SAQ Alcohol Scale score can help treatment staff work through offender denial. More people accept objective standardized assessment results as opposed to someone's subjective opinion. This is especially true when it is explained that the SAQ has been given to thousands of substance (alcohol and other drugs) users and abusers. Elevated scores do not occur by chance as they require a sequence of deviant answers. The Alcohol Scale can be interpreted independently on in combination with other SAQ elevated scale scores.

3. Drugs Scale: measures drug use and the severity of drug abuse. The term drugs refers to marijuana, ice, ecstacy, cocaine, amphetamines, barbiturates, heroin, etc. It also screens prescription drug abuse. An elevated (70 to 89th percentile) Drug Scale score identifies emerging drug problems. A Drugs Scale score in the severe problem (90 to 100th percentile) range identifies established and severe drug abuse.

A history of drug-related problems (e.g., drugs arrests, prior DUI/DWI convictions, drug treatment, etc.) could result in an abstainer (current non-user) attaining a low to medium risk Drugs Scale score. Consequently, precautions have been built into the SAQ to ensure correct identification of "recovering" drug abusers. The client's answer to the "recovering drug abuser" question (item #152) is printed in the "significant items" section of the SAQ report.

Concurrently elevated Drugs Scale and Alcohol Scale scores are indicative of polysubstance abuse. When both the Drugs Scale and Alcohol scale scores are in the severe problem range, polysubstance abuse is present and the highest score usually reflects the client's substance of choice. Any Drugs Scale score in the severe problem (90 to 100th percentile) range should be taken seriously. Drug abuse can exacerbate aggressiveness, resistance, substance abuse and impaired stress management abilities. The Drugs Scale can be interpreted independently or in combination with other SAQ scales.

4. Aggressiveness Scale: measures aggressiveness or acting out behavior. Aggressiveness is often defined as striving for social dominance with a tendency toward hostility. Aggressiveness is often characterized by a lack of social concern for others. Aggressive conduct disorders often reflect domineering, punitive and at the extreme even verbal and/or physical assaultive behaviors.

An elevated (70th percentile and higher) Agressiveness Scale score is indicitive of increased risk-taking behavior, acting out potential and impulsiveness. Severe Aggressiveness (90 to 100th percentile) scores represent extreme aggressiveness which can lead into acting out, argumentation and violence. Characteristics usually include lack of social concern, disrespect of others' property and rights. Severe problem scorers often cross the line between aggressive behavior and inappropriate acting out. Aggressiveness is particularly troublesome in clients also scoring in elevated Alcohol Scale, Drugs Scale, Resistance Scale and Stress Management Scale score ranges. The addage "The higher the scale score the more problematic the problem behavior" applies.

An aggressive person that also has high substance (alcohol and/or drugs) abuse problem, or manifests a severe Resistance Scale score is particularly dangerous. A client with a severe aggressiveness problem becomes even more bothersome and distracting with concurrently elevated Resistance Scale and Stress Management Scale scores. The Aggressiveness Scale can be interpreted independently or in combination with other SAQ scales.

5. Resistance Scale: measures noncompliance, resistance to help and uncooperativeness. This scale's score varies directly with the client's attitude and behavior. Some people resist help whereas other accept it. In the case of patients, those that are labeled resistant often appear unmotivated, oppositional and uncooperative. Their denial is a major defense mechanism. Other resistant behaviors have been explained in terms of a variety of defense mechanisms like denial, projection, reaction formation, passive aggressiveness, rationalization, etc.

An elevated (70th percentile and higher) Resistance Scale score identifies defensive, non-compliant, and oppositional individuals. These people often respond positively to clarification of their expectations and consequences. They can be fault-finding, disrespectful, and defiant. A severe problem (90 to 100th percentile) Resistance Scale score reflects extreme non-compliance, resistance and even defiance. These clients are often passive-aggressive, hostile and can be antagonistic. They usually have a lot of characterological armour. They often resist authority, reject help and are very protective of personal information.

Resistance has character trait features and as such resistance can be an enduring facet of a person's personality. Patients with alcoholism or chronic drug abuse are commonly described as resistant people. One might expect an elevated Truthfullness Scale to accompany an elevated Resistance Scale score. Resistant people often manifest situation specific anger. A resistant attitude often accompanies a client's decision to refuse to continue in treatment. Disrespect, confrontive behaviors and negative staff or mental health professionals can create noncompliance barriers. The Resistance Scale can be interpreted independently of the other SAQ scales.

6. Stress Management Scale: measures the clients ability to handle, cope with, or positively manage stress, tension and pressure. How well a person manages stress largely determines their positive or negative adjustment. A Stress Management Scale score in the elevated (70 to 89th percentile) range reflects deteriorating or impaired stress management strategies, techniques and adjustment. Elevated Stress Management Scale scores can provide considerable insight into co-determinants of adjustment problems. Impaired stress management strategies, techniques and skills impact directly upon other SAQ scales, like substance (alcohol and other drugs) abuse; resistance/guardedness/denial; and aggressiveness or acting out inappropriately. A Stress Management Scale score in the severe (90 to 100th percentile) problem range may be indicative of a serious emotional or mental health problem. Sometimes this may warrant a comprehensive psychological evaluation.

A particularly unstable and perilous condition involves a severe (90 to 100th percentile) Stress Management Scale score in conjunction with any other (alcohol, drugs, resistance, aggressiveness) severe SAQ scale scores. Some therapists maintain that proper stress management is a necessary prerequisite for continued recovery and relapse prevention. Stress Management strategies and techniques are taught in classes, group counseling and individually. Techniques vary from establishing a proper diet, getting adequate sleep, and building exercise into your daily life. Also helpful are deep breating exercises, meditation, and positive reframing of ones' thoughts. The Stress Management Scale can be interpreted independantly or in combination with other elevated SAQ scale scores.

Conclusion

In conclusion, it was noted that there are several "levels" of Substance Abuse Questionnaire (SAQ) interpretations, ranging from viewing the SAQ as a self-report, to interpreting scale elevations and inter-relationships. Staff can then put SAQ test report findings within the context of the client's adjustment and life situation.

Additional information can be provided upon request.

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