Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.1)

Foundational Context

The ASSIST was created by the WHO ASSIST Working Group to provide a globally standardized tool for identifying risky substance use across diverse settings and cultures. Earlier substance-use tools tended to focus on a single substance (e.g., AUDIT for alcohol), leaving clinicians without a comprehensive multi-substance approach. The ASSIST addresses this gap by screening nine major substance classes with validated scoring thresholds for each.

The tool was developed through international field trials (WHO ASSIST Working Group, 2002) and further validated in multiple countries (Humeniuk et al., 2008). Version 3.1 refined scoring guidance and brief intervention protocols based on extensive clinical implementation results. Today, ASSIST is widely considered one of the most practical and evidence-supported tools for early detection of substance-related risk in adults.

What the Assessment Measures

The ASSIST examines substance involvement across commonly used substances, focusing on patterns that predict health, social, and dependency-related outcomes.

The assessment measures:

• Recent use (past 3 months) across multiple drug categories
• Lifetime exposure
• Cravings and urges to use
• Loss of control or failed efforts to cut down
• Problems caused by use (health, social, legal)
• Concern expressed by others
• Injection drug use (risk flag, not part of scoring)

The output is a Substance Involvement (SI) Score for each drug class, providing a clear picture of risk level across substances.

Interpretation Guidelines

ASSIST scoring categorizes each substance into three risk levels:

Alcohol

• 0–10: Low risk
• 11–26: Moderate risk (brief intervention recommended)
• 27+: High risk / possible dependence (assessment and specialty referral recommended)

All Other Substances

• 0–3: Low risk
• 4–26: Moderate risk
• 27+: High risk / possible dependence

Interpretation Notes:

• These thresholds come directly from WHO v3.1 guidelines.
• Scores reflect risk, not diagnosis.
• High scores suggest problematic use patterns that may warrant more structured assessment (e.g., DSM-based evaluation, clinical interview).
• Q8–Q10 do not contribute to SI Scores but offer clinically meaningful information about perceived problems, external concern, and prior failures to control use.
• Injection use questions flag high-risk behaviour requiring immediate clinical attention.

Interpretation should always consider cultural context, co-occurring mental health symptoms, and the individual’s functional impact.

Psychometric Properties

Reliability

Research demonstrates:

• High internal consistency across substance categories
• Strong test–retest reliability in multi-country validation samples
• Consistent performance across demographic subgroups (WHO ASSIST Working Group, 2002)

Validity

• Strong convergent validity with AUDIT, DAST, and other validated substance-use measures
• Discriminant validity demonstrating ability to differentiate risk levels across substances
• Predictive utility for identifying individuals who benefit from brief intervention (Humeniuk et al., 2008)
• Validated across multiple cultures and languages, supporting global adaptation

Administration Considerations

• Designed for use in primary care, community health, mental health, and addiction services
• Can be administered via structured self-report or clinician interview
• Takes approximately 5–10 minutes
• Works best when delivered in a non-judgmental, supportive tone
• May require clarification for some question concepts, especially in culturally diverse settings
• Individuals with cognitive impairment or acute intoxication may require clinician-assisted administration

Limitations

• Not a diagnostic tool for substance-use disorders
• Self-report bias may influence responses
• Cultural interpretation of substance use can affect item responses
• Injection-use questions may require further risk-specific assessment
• Does not assess withdrawal symptoms or medical complications