Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-3)

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Developed by the World Health Organization, the ASSIST-3 helps identify risk levels associated with alcohol, tobacco, and other substance use. Designed for use in primary care and mental health settings, it captures both current and lifetime use patterns across a range of substances. Used internationally and freely available for clinical use.

At a Glance

  • Name: Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-3)
  • Abbreviation: ASSIST-3
  • Length: 8 items per substance category
  • Format: Structured interview with multiple-choice responses
  • Population: Adults (ages 18+)
  • Validated Use: WHO-recommended tool for primary care and mental health settings

Recommended Frequency: Every 6–12 months, or as clinically indicated

🧭 What It Measures

The ASSIST-3 is a structured screening tool developed by the World Health Organization to identify risk levels related to the use of alcohol, tobacco, and other substances. It helps highlight patterns of recent and lifetime use, and related health or social consequences.

ASSIST-3 is designed to detect problematic or risky substance use across 10 categories of substances, including:

  • Alcohol
  • Tobacco
  • Cannabis
  • Cocaine
  • Amphetamine-type stimulants
  • Inhalants
  • Sedatives
  • Hallucinogens
  • Opioids
  • Other drugs

The tool was developed under WHO’s initiative to improve early detection of substance use and guide brief interventions, with strong cross-cultural validation.

Each category assesses:

  • Lifetime use
  • Frequency of use in the past 3 months
  • Cravings
  • Health, social, legal, or financial consequences
  • Concern from others
  • Failed attempts to reduce use
  • Injection drug use (any substance)

The structure of the ASSIST allows for nuanced understanding of risk severity, guiding whether no intervention, a brief intervention, or intensive treatment is warranted.

Psychometric Properties

The ASSIST showed internal Consistency (Chronbach’s alpha) was over 0.80 for the majority of domains and ASSIST items correlated well against similarly worded items of other questionnaires. In addition, the ASSIST shows excellent concurrent, construct, predictive and discriminative validity and can adequately screen for low, moderate and high risk substance use for any substance.

Sources:

https://www.who.int/docs/default-source/substance-use/who-psa-93-10.pdf

The Scale

The full ASSIST-3 includes 8 core questions repeated across 10 substance categories, plus 1 item about injection drug use. The reference window is the past 3 months, except for the first item (lifetime use). Each response contributes to a Substance Involvement Score (SIS), unique for each substance, which reflects risk level (Low, Moderate, High).

HiBoop displays each substance’s score independently so clinicians can prioritize targeted interventions and integrate findings into the treatment plan.

Learn more

The ASSIST in Practice

Many clinicians use the ASSIST alongside the AUDIT-C, DAST-10, or mental health measures to create a holistic view of risk and comorbidity. Consider exploring:

  • Whether the client uses substances to self-regulate other symptoms
  • How substance use interacts with medication adherence
  • Environmental, relational, or occupational impacts

HiBoop allows clinicians to track changes in scores over time, ideal for monitoring harm-reduction or abstinence goals.

Copyright

© World Health Organization

References

  • WHO ASSIST Working Group. (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility. Addiction, 97(9), 1183–1194.
  • WHO. (2010). ASSIST: Manual for use in primary care. Geneva: World Health Organization.

Disclaimer

  • Copyright: © World Health Organization
  • Permissions Note: Freely available under WHO public domain guidelines.
  • Disclaimer: For informational purposes only. Not a substitute for clinical guidance.

Permissions

Freely available under WHO public domain guidelines with citetation.

Frequently Asked Questions

  • Can the ASSIST-3 diagnose substance use disorders?

    No, it is a screening and triage tool. It can identify risky use, but formal diagnosis requires clinical assessment and DSM-5 criteria.

  • How long does it take to complete?

    10–15 minutes when administered by a clinician. Slightly longer if follow-up questions are needed.

  • Should I administer the full tool or just the screener?

    We recommend the full version unless time or client circumstances suggest otherwise.

  • Can I use it with clients not currently using substances?

    Yes—it covers lifetime use and can help uncover histories relevant to treatment planning.

  • How do I discuss sensitive topics like injection drug use?

    Approach with empathy, use neutral language, and emphasize that the goal is not judgment but understanding patterns of behaviour and health risk.

  • What should I do if a client scores in the ‘High Risk’ range?

    Discuss concerns openly, offer referral options, and, if appropriate, initiate harm-reduction planning or a warm handoff to addiction services.

  • Can I use the ASSIST remotely?

    Yes, though it is most effective when discussed in real time. Consider using HiBoop’s secure link feature for remote screening prior to a session.