Toronto’s Mayor, Rob Ford was interviewed in part along with
his brother by Matt Lauer. In the
interview, Mayor Ford strongly denied he had a problem with alcohol or
drugs. His brother and advisor,
Councilman Doug Ford, echoed his brother’s statements. Mr. Lauer applauded Doug Ford as being noble
and supportive of his brother and then proceeded to ask him if he had any
concerns about his brother, Rob’s, behaviors or issues. The brother replied that he was concerned
especially whenever his brother binge drinks. . . . to which Rob Ford added,
“But I don’t do it all the time . . . only on occasion.” One of the greatest myths about drugs and
alcohol is that an addicted person must drink or use every day before being
One would think that such a statement of admission of “occasional
binge drinking,” and the concern of others when he does so, to be an out and
out behavior of severe abuse if not dependency.
To this substance abuse counselor, making such a remark is analogous to
a pregnant woman saying, “I’m just a little bit pregnant.”
It’s all in the perception.
Addicts and alcoholics have their own perception that they use to
justify their use of their drug of choice. One of three assessment tools that I use is
one called the Substance Abuse Subtle Screening Inventory (SASSI-3). It consists of 67 True or False questions
that do not have a “right” or “wrong” answer. Some
of the 67 questions deal with general lifetime questions of behavior that do
not appear to have anything to do with drugs or alcohol. They are designed to indicate the client’s
perceptions, values, and attitudes about him/herself and their life.
Then there are another 12 Questions on another side of the
questionnaire that deal specifically with alcohol use in the last 6 months, 12
months, or year. There are an additional
separate 14 questions specifically pertaining to the use of drugs. I prefer to have the client respond fover the
last 12 months.
Interpretation is based upon objective scoring based upon
years of study of how thousands of alcoholics and addicts have responded to the
same questions. It has an overall
empirically tested accuracy of 93-94% of correctly identifying substance
dependent people. It also has a 93%
correct identification of non-substance dependent people. It measures one’s Symptoms, Obvious Attributes,
Subtle Attributes, Defensiveness, and Supplemental Addiction Measure. It also tests to see if the client comprehends
the written words or is just answering randomly.
More often than not, I find scores indicating a history of
several abuse while, at the same time, indicating no symptoms or obvious
attributes. And when a Defensiveness
score is high, the test indicates that the client is misleading, lying, or
trying to come across in a more favorable light. In any case, the test is not valid and it informs
the clinician that the test may have missed a substance dependent person.
I recently did an evaluation on a young man who had received
2 DUI arrests for the use of Cannabis.
His symptoms and behaviors were well below what they average drinker or occasional
drug user would score. He reported he
hadn’t used pot in the last 18 months yet his DUI was only 12 months ago. His Defensiveness score was 11 out of a
possible 11. A score of 8 indicates a
problem of not being truthful or minimizing and this client’s score was as high
as it could be. While such a high score
could indicate lying or minimizing, it can also indicate something about the
client’s overall personality and it is up to the clinician to attempt to narrow
the causes down.
I called the client on his Defensiveness score and checked
to see if anything recently was going on in his life with conflict with someone
important to him or other possible situations existing for him to be so
defensive. I also checked to see if this
was part of his personality makeup.
After delving into several possibilities that would be an acceptable
character trait for the client, all evidence indicated otherwise. When I informed him that he had responded
defensively 100% of how an addict/alcoholic would respond, he quickly reminded
me that it was based upon his perception of the questions. I agreed and
reminded him that I explained that the answers to the questions would be based
upon his perceptions before he even began to take the tests. No matter how much I attempted to explain to
him that his perceptions were identical to those of an addict’s and not to
those of non-addicts, he continued to justify his high score by saying it was
“Only my perception!” He failed to
perceive that it was precisely his perceptions that indicted he was substance
The brain will believe whatever we put into it. It does not know the difference between fact
and fiction. Our perception is based
upon our filters of total knowledge and values.
The perceptions of an addict or alcoholic are distorted by drugs and
alcohol. They often fail to see that
they have a dependency problem while all those around them may see it
clearly. Some call it “Denial.” Others call it “anosognosia.” Still others will call it “A character Disorder
“or even “a mental illness.” Whatever
one wishes to call it, it will always be a refusal or unwillingness to accept
the reality of a given situation. And
nothing will ever change until it becomes real.
I gave this client an opportunity to justify his perceptions
by requesting he provide me with a urine sample which I could test in my
office. He refused. At least one of his perceptions must have