INTRODUCTION TO THE ASSIST

(Alcohol, Smoking and Substance

Involvement Screening Test)

State Level Coordinating Agency

of Ministry of Social Justice & Empowerment, Govt. of India
What is ASSIST?

Alcohol, Smoking & Substance Involvement

Screening Test
8 item questionnaire (paper & pen)
Administration time approx. 10 minutes
What does the ASSIST do?

 Screens for risky substance use

 tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants,
sedatives, hallucinogens, inhalants, opioids, ‘other drugs’
 Determines risk score for each substance
 Low, moderate or high risk
 Dependent/high risk users more easily identified than
those at moderate risk
 Both moderate and high-risk (dependent) substance users
place burden on public health care systems
Why use the ASSIST?

Remember! – people use substances because they

have pleasurable or desirable effects.
Problems can arise as a result of:
 Acute intoxication
 Regular use
 Dependence
 Injecting behaviour
The ASSIST covers a range of these problems
Where to use the ASSIST?

Settings
Health care General welfare Speciality Centres Organizations

Primary care Correctional STD Clinics Any Work place

Services

Community care Vocational Psychiatry NGOs, Youth

Services Org.

Tertiary care Drop-in – Obstetrics

Centres/VCTC
Who will use the ASSIST?

Health care professionals Paramedical General welfare

General Practitioners Health Workers Social Workers

Nurses Mid Wives Correctional Officers

Interns Health Educator Managers at workplace

Counsellors
OVERVIEW OF THE ASSIST

Questions asked for all substance groups

 Lifetime use
 Q1 Ever used

 Last 3 months
 Q2 Frequency of use
 Q3 Desire to use
 Q4 Health, social, legal, financial problems
 Q5 Failure to fulfil role obligations

 Lifetime use
 Q6 Concern by others
 Q7 Failed attempts to control use
 Q8 Injecting behaviour
How to Score ASSIST
Considering the Client

Clients most likely to respond positively & honestly

to ASSIST questions if health worker:
 Shows they are listening
 Is friendly & non-judgemental
 Shows sensitivity & empathy
 Explains limits of confidentiality
 Remains objective
Introducing the ASSIST to clients

ASSIST questionnaire (HO6A) comes with

introduction (may be modified to suit circumstances)
BUT introduction must include:
 Response Card for clients (HO7)
 List of substances & terms used
 Last 3 months / lifetime
 Non-prescribed use only
 Limits of confidentiality
Write your responses in front of the question. Report
your answers in the workbook.

OPTIONS
 never
 once or twice
 monthly
 weekly
 daily/almost daily
 Good questionnaire administration

• Hold questionnaire so client can’t see – otherwise

may influence client’s response
• Every response for every drug and every question
must be circled - including all zeros or negative
responses – otherwise easy to confuse drugs when
adding up and get scoring wrong
• May need to re-phrase questions for some clients
• Will need to provide prompts for some questions (eg.
Q4)
 ASSIST Filter questions

Question 1 If “no” to all End of Calculate

Interview Score
If “yes”
to any
substance
Question 2 If “never” to Questions
all 6, 7 & 8
If “yes”
to any
substance
Questions
3, 4 & 5
What do ASSIST Scores mean?

• Alcohol (Q2 to Q7)

• Score 0 - 10 = Low Risk
• Score 11 - 26 = Moderate Risk
• Score of 27 or higher = High Risk

• All other substances (Q2 to Q7)

• Score 0 - 3 = Low Risk
• Score 4 - 26 = Moderate Risk
• Score of 27 or higher = High Risk
How to score ASSIST

• Each ASSIST question has set of responses to choose from

(e.g.. monthly, weekly etc.)
• Each response has a specific numerical score (e.g.
Question 2 has scores of 0, 2, 3, 4 or 6)
• Circle the numerical score for each substance – even if it is
zero
• Scores from Q2 through to Q7 are added together for each
substance type to get a Specific Substance Involvement
Score
• Record scores in box provided on last page (HO6)
How to calculate a specific substance
involvement (SSI) score?
• For each substance (labelled a. to j.) add up the
scores received for questions 2 through 7 inclusive.
Do not include the results from either Q1 or Q8 in
this score. For example, a score for cannabis would
be calculated as:
Q2c + Q3c + Q4c + Q5c + Q6c + Q7c

• Note that Q5 for tobacco is not coded, and is

calculated as: Q2a + Q3a + Q4a + Q6a + Q7a
 Example – Scoring a Specific Substance
Involvement Score (ASSIST score) for Cannabis

 A client has given the following answers on the ASSIST for cannabis
Q2c In the past three months, how often have you used Cannabis? Weekly Score=4

Q3c During the past three months, how often have you Once or Twice Score=3
had a strong desire or urge to use Cannabis?

Q4c During the past three months, how often has your Monthly Score=5
use of Cannabis led to health, social, legal or financial problems?

Q5c During the past three months, how often have you failed Once or Twice Score=5
to do what was normally expected of you because of
your use of Cannabis?

Q6c Has a friend or relative or anyone else ever Yes, but not in past 3 months Score=3
expressed concern about your use of
Cannabis?

Q7c Have you ever tried and failed to control, cut down or stop using No, never Score=0
Cannabis?

Total Q2c+Q3c+Q4c+Q5c+Q6c+Q7c SSI Score Score=20

Scores are similarly calculated for all other substances with the exception of tobacco
which does not include Q5 in the calculation
Response card for clients (HO7)
1
Tobacco products (cigarettes, chewing tobacco, cigars, etc.)
2 Alcoholic beverages (beer, wine, spirits, etc.)
3 Cannabis (marijuana, dope, pot, grass, hash, etc.)
4 Cocaine (coke, crack, etc.)
5 Amphetamine-type stimulants (speed, meth, ecstasy, ice, etc.)
6 Inhalants (nitrous, glue, petrol, thinners, solvents, sprays, etc.)
7 Sedatives or Sleeping Pills (Diazepam, Alprazolam, Temazepam, etc.)

8 Hallucinogens (LSD, acid, trips, mushrooms, Ketamine, etc.)

9 Opioids (heroin, morphine, opium, methadone, codeine, etc.)
10 Other - specify:
Response card for clients

Response Card (ASSIST Questions 2 to 5)

Never: not used in the last 3 months
Once or twice: 1 to 2 times in the last 3 months.
Monthly: average of 1 to 3 times per month in last 3 months
Weekly: 1 to 4 times per week.
Daily or almost daily: 5 to 7 days per week.

Response Card (ASSIST Questions 6 to 8)

No, Never
Yes, but not in the past 3 months
Yes, in the past 3 months
What do ASSIST Scores mean?

• Alcohol (Q2 to Q7)

• Score 0 - 10 = Low Risk
• Score 11 - 26 = Moderate Risk
• Score of 27 or higher = High Risk

• All other substances (Q2 to Q7)

• Score 0 - 3 = Low Risk
• Score 4 - 26 = Moderate Risk
• Score of 27 or higher = High Risk
What do ASSIST Scores mean?

• Low Risk
• While these clients may use substances occasionally, they are not currently
experiencing any problems related to their use and are at low risk of
developing health or other problems related to their use in the future
• Moderate Risk
• Clients are at moderate risk of health and other problems and may be
experiencing some of these problems now. Continuing use in this way
indicates a likelihood of future health and other problems, including the
possibility of dependence.
• Risk is increased for those with a past history of substance problems and
dependence.
• High Risk
• These clients are experiencing severe health and other problems and are
likely dependent on the substance(s).
Linking ASSIST scores to the appropriate
intervention
•Low Risk
• Support, Promote Healthy behaviour
• Moderate Risk
• Brief Intervention
• Take-home materials
• High Risk
• Further assessment and referral to specialist drug & alcohol
treatment service
• Use Brief Intervention as referral tool
What do ASSIST Scores mean?

• Low Risk
• While these clients may use substances occasionally, they are not currently
experiencing any problems related to their use and are at low risk of
developing health or other problems related to their use in the future
• Moderate Risk
• Clients are at moderate risk of health and other problems and may be
experiencing some of these problems now. Continuing use in this way
indicates a likelihood of future health and other problems, including the
possibility of dependence.
• Risk is increased for those with a past history of substance problems and
dependence.
• High Risk
• These clients are experiencing severe health and other problems and are
likely dependent on the substance(s).
THANK YOU