Alcohol, Smoking and Substance Involvement Screening Test

The ASSIST was developed for the World Health Organization (WHO) to detect hazardous and harmful substance use in primary health care. A health worker asks eight questions in an interview, covering tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives and sleeping pills, hallucinogens, opioids and other drugs. It takes about 5–10 minutes.

The ASSIST asks which substances have ever been used, and then, for the last three months, how often each was used, how often there was a strong desire to use it, how often it led to health, social, legal or financial problems, and how often it got in the way of everyday responsibilities. It also asks whether others have expressed concern, whether attempts to cut down have failed, and whether any substance has been injected. Adding the scores of questions 2 to 7 gives a separate risk score for each substance. Lower risk: 0–3 for all substances except alcohol (0–10). Moderate risk: 4–26 (alcohol 11–26). High risk: 27 or more. Injecting is not part of the score but is an important risk indicator.

Health workers use the ASSIST to screen for the full range of substances in one interview, and to start a brief conversation with the patient about their risk for each substance. According to the WHO manual, moderate scores are likely to indicate hazardous or harmful use and high scores are likely to indicate dependence.

The ASSIST was developed by an international group of researchers on behalf of the WHO. Development began with a study in Australia, Brazil, India, Ireland, Israel, the Palestinian Self-Rule Areas, Puerto Rico, the United Kingdom and Zimbabwe. The WHO manual for use in primary care was published in 2010.

Between 2000 and 2002, the ASSIST was validated in primary health care and drug treatment settings in Australia, Brazil, India, Thailand, the United Kingdom, the United States and Zimbabwe. The study showed good concurrent, construct, predictive and discriminant validity and produced the cutoffs for lower, moderate and high risk. A later trial showed that people who received a brief intervention based on their ASSIST scores reduced their use of illicit substances more than those who did not.

According to the WHO manual, the ASSIST has so far only been validated as an interview and not for self-completion, and only for adults aged 18 to 60. It has not been formally validated in pregnant women. Version 3.1 is intended for clinical use, while version 3.0 is advised for research.