[{"data":1,"prerenderedAt":1180},["ShallowReactive",2],{"assessment-assist":3,"all-assessments-nav":353,"related-assessments-query":1025},{"id":4,"title":5,"body":6,"category":305,"categoryTitle":306,"clinicalCitations":307,"copyright":317,"description":318,"downloadLink":305,"extension":319,"faqs":320,"featured":333,"i18nReady":333,"icon":305,"interpreter":305,"lastReviewed":334,"meta":335,"navigation":336,"path":337,"permissionsNote":338,"published":336,"recommendedFrequency":339,"relatedCodes":305,"relatedConditions":305,"reviewedBy":305,"seo":340,"slug":341,"stem":342,"summary":343,"takeaways":305,"timeline":344,"type":351,"usedToDiagnose":305,"__hash__":352},"assessments\u002Fassessments\u002Fassist.md","Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.1)",{"type":7,"value":8,"toc":288},"minimark",[9,14,27,30,34,41,46,88,95,99,102,107,127,131,149,154,179,182,186,190,193,204,208,229,233,267,271],[10,11,13],"h2",{"id":12},"foundational-context","Foundational Context",[15,16,17,18,22,23,26],"p",{},"The ASSIST was created by the World Health Organization ASSIST Working Group to provide a ",[19,20,21],"strong",{},"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 ",[19,24,25],{},"nine major substance classes"," with validated scoring thresholds for each.",[15,28,29],{},"The tool was developed through international field trials (World Health Organization 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.",[10,31,33],{"id":32},"what-the-assessment-measures","What the Assessment Measures",[15,35,36,37,40],{},"The ASSIST examines ",[19,38,39],{},"substance involvement"," across commonly used substances, focusing on patterns that predict health, social, and dependency-related outcomes.",[15,42,43],{},[19,44,45],{},"The assessment measures:",[47,48,49,56,61,66,71,77,82],"ul",{},[50,51,52,55],"li",{},[19,53,54],{},"Recent use"," (past 3 months) across multiple drug categories",[50,57,58],{},[19,59,60],{},"Lifetime exposure",[50,62,63],{},[19,64,65],{},"Cravings and urges to use",[50,67,68],{},[19,69,70],{},"Loss of control or failed efforts to cut down",[50,72,73,76],{},[19,74,75],{},"Problems caused by use"," (health, social, legal)",[50,78,79],{},[19,80,81],{},"Concern expressed by others",[50,83,84,87],{},[19,85,86],{},"Injection drug use"," (risk flag, not part of scoring)",[15,89,90,91,94],{},"The output is a ",[19,92,93],{},"Substance Involvement (SI) Score"," for each drug class, providing a clear picture of risk level across substances.",[10,96,98],{"id":97},"interpretation-guidelines","Interpretation Guidelines",[15,100,101],{},"ASSIST scoring categorizes each substance into three risk levels:",[103,104,106],"h3",{"id":105},"alcohol","Alcohol",[47,108,109,115,121],{},[50,110,111,114],{},[19,112,113],{},"0–10:"," Low risk",[50,116,117,120],{},[19,118,119],{},"11–26:"," Moderate risk (brief intervention recommended)",[50,122,123,126],{},[19,124,125],{},"27+:"," High risk \u002F possible dependence (assessment and specialty referral recommended)",[103,128,130],{"id":129},"all-other-substances","All Other Substances",[47,132,133,138,144],{},[50,134,135,114],{},[19,136,137],{},"0–3:",[50,139,140,143],{},[19,141,142],{},"4–26:"," Moderate risk",[50,145,146,148],{},[19,147,125],{}," High risk \u002F possible dependence",[15,150,151],{},[19,152,153],{},"Interpretation Notes:",[47,155,156,159,166,169,176],{},[50,157,158],{},"These thresholds come directly from World Health Organization v3.1 guidelines.",[50,160,161,162,165],{},"Scores reflect ",[19,163,164],{},"risk",", not diagnosis.",[50,167,168],{},"High scores suggest problematic use patterns that may warrant more structured assessment (e.g., DSM-based evaluation, clinical interview).",[50,170,171,172,175],{},"Q8–Q10 do ",[19,173,174],{},"not"," contribute to SI Scores but offer clinically meaningful information about perceived problems, external concern, and prior failures to control use.",[50,177,178],{},"Injection use questions flag high-risk behaviour requiring immediate clinical attention.",[15,180,181],{},"Interpretation should always consider cultural context, co-occurring mental health symptoms, and the individual’s functional impact.",[10,183,185],{"id":184},"psychometric-properties","Psychometric Properties",[103,187,189],{"id":188},"reliability","Reliability",[15,191,192],{},"Research demonstrates:",[47,194,195,198,201],{},[50,196,197],{},"High internal consistency across substance categories",[50,199,200],{},"Strong test–retest reliability in multi-country validation samples",[50,202,203],{},"Consistent performance across demographic subgroups (World Health Organization ASSIST Working Group, 2002)",[103,205,207],{"id":206},"validity","Validity",[47,209,210,217,223,226],{},[50,211,212,213,216],{},"Strong ",[19,214,215],{},"convergent validity"," with AUDIT, DAST, and other validated substance-use measures",[50,218,219,222],{},[19,220,221],{},"Discriminant validity"," demonstrating ability to differentiate risk levels across substances",[50,224,225],{},"Predictive utility for identifying individuals who benefit from brief intervention (Humeniuk et al., 2008)",[50,227,228],{},"Validated across multiple cultures and languages, supporting global adaptation",[10,230,232],{"id":231},"administration-considerations","Administration Considerations",[47,234,235,252,255,258,261,264],{},[50,236,237,238,241,242,241,245,248,249],{},"Designed for use in ",[19,239,240],{},"primary care",", ",[19,243,244],{},"community health",[19,246,247],{},"mental health",", and ",[19,250,251],{},"addiction services",[50,253,254],{},"Can be administered via structured self-report or clinician interview",[50,256,257],{},"Takes approximately 5–10 minutes",[50,259,260],{},"Works best when delivered in a non-judgmental, supportive tone",[50,262,263],{},"May require clarification for some question concepts, especially in culturally diverse settings",[50,265,266],{},"Individuals with cognitive impairment or acute intoxication may require clinician-assisted administration",[10,268,270],{"id":269},"limitations","Limitations",[47,272,273,276,279,282,285],{},[50,274,275],{},"Not a diagnostic tool for substance-use disorders",[50,277,278],{},"Self-report bias may influence responses",[50,280,281],{},"Cultural interpretation of substance use can affect item responses",[50,283,284],{},"Injection-use questions may require further risk-specific assessment",[50,286,287],{},"Does not assess withdrawal symptoms or medical complications",{"title":289,"searchDepth":290,"depth":290,"links":291},"",3,[292,294,295,299,303,304],{"id":12,"depth":293,"text":13},2,{"id":32,"depth":293,"text":33},{"id":97,"depth":293,"text":98,"children":296},[297,298],{"id":105,"depth":290,"text":106},{"id":129,"depth":290,"text":130},{"id":184,"depth":293,"text":185,"children":300},[301,302],{"id":188,"depth":290,"text":189},{"id":206,"depth":290,"text":207},{"id":231,"depth":293,"text":232},{"id":269,"depth":293,"text":270},null,"Substance Use",[308,311,314],{"text":309,"link":310},"Humeniuk R, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwutikarn J, de Lacerda RB, Ling W, Marsden J, Monteiro M, Nhiwatiwa S, Pal H, Poznyak V, Simon S. Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST). Addiction. 2008;103(6):1039-47.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F18373724\u002F",{"text":312,"link":313},"WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183-94.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F12199834\u002F",{"text":315,"link":316},"Newcombe DA, Humeniuk RE, Ali R. Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site. Drug Alcohol Rev. 2005;24(3):217-26.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F16096125\u002F","© World Health Organization. The ASSIST-3 is part of the World Health Organization Mental Health and Substance Use initiative and is publicly available.","ASSIST v3.1 (World Health Organization): screens 8+ substance classes, Substance Involvement Score flags low\u002Fmoderate\u002Fhigh risk. Primary care and mental health substance use screening tool.","md",[321,324,327,330],{"question":322,"answer":323},"How is the ASSIST scored?","The ASSIST generates a Substance Involvement (SI) Score separately for each of the nine substance classes it screens. Items 2 through 7 contribute to the SI Score for each substance; items 8 through 10 provide additional clinical context but do not contribute to the score. Injection drug use is flagged independently and does not feed into SI Score totals.",{"question":325,"answer":326},"What do the ASSIST risk levels mean?","For alcohol, scores of 0–10 indicate low risk, 11–26 indicate moderate risk, and 27 or above indicate high risk with possible dependence. For all other substances, the thresholds are 0–3 (low), 4–26 (moderate), and 27+ (high). These cutoffs derive from the WHO v3.1 scoring guidelines and were established using receiver operating characteristic analysis in the international validation study (Humeniuk et al., 2008).",{"question":328,"answer":329},"Can the ASSIST diagnose a substance use disorder?","No. The ASSIST is a screening tool designed to identify risk levels and guide triage, not to establish a diagnosis. A high SI Score indicates a pattern that warrants further clinical evaluation — such as a structured diagnostic interview using DSM or ICD criteria — but the score alone does not constitute a diagnosis of a substance use disorder.",{"question":331,"answer":332},"Is the ASSIST self-report or clinician-administered?","The ASSIST is designed for both formats. It can be completed by the individual as a structured self-report questionnaire or administered by a clinician in an interview format. Research has shown consistent performance across both delivery modes; clinician-assisted administration may be preferable for individuals with low literacy or cognitive difficulty.",false,"2026-06-03",{},true,"\u002Fassessments\u002Fassist","The ASSIST v3.1 is published by the World Health Organization and is freely available for clinical use. Reproduction of the full questionnaire may require proper citation or permission according to World Health Organization guidelines. Cite the official World Health Organization ASSIST manual when referencing the tool.","At initial assessment or intake, especially in primary care or mental health settings\n\nEvery 6–12 months for ongoing monitoring\n\nAfter major health or behavioural changes (e.g., relapse, medication shifts)\n\nAny time substance use is suspected or clinically relevant\n",{"title":5,"description":318},"assist","assessments\u002Fassist","The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.1) is a comprehensive screening tool developed by the World Health Organization (World Health Organization) to identify substance use and categorize risk levels across multiple substance classes. It evaluates recent use, cravings, health\u002Fsocial\u002Flegal consequences, and prior attempts to control use. \n\nThe ASSIST provides a standardized Substance Involvement (SI) Score for each substance, allowing clinicians to differentiate low-, moderate-, and high-risk patterns. These SI scores support early detection, brief intervention planning, and referral pathways for specialized care when needed. While widely used in primary care, mental health, and substance-use settings, the ASSIST is a screening tool, not a diagnostic instrument.\n",[345,348],{"year":346,"label":347},"2002","ASSIST instrument developed and initial reliability\u002Ffeasibility established across nine international sites (WHO ASSIST Working Group)",{"year":349,"label":350},"2008","Multi-site international validation study confirms concurrent, construct, and discriminative validity across substance classes (Humeniuk et 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