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

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The ASSIST-3 is a structured screening tool developed by the World Health Organization to detect substance use and related health risks across a broad range of substances. It identifies both lifetime and recent use patterns to help inform intervention strategies in medical, mental health, and addiction settings.

Recommended Frequency: At intake or initial assessment; repeat every 3–6 months in active treatment or higher-risk populations, or as clinically indicated.

About the ASSIST-3

The ASSIST-3 was designed as part of a WHO international initiative to support early detection of substance use problems across diverse care settings. It screens for use of 10 substance categories (e.g., alcohol, tobacco, cannabis, opioids, stimulants) and collects information on both recent and lifetime use, craving, social/legal impacts, and prior treatment.

It is often used in primary care, behavioral health, and community health settings, including integration into SBIRT (Screening, Brief Intervention, and Referral to Treatment) workflows.

Psychometric Properties

The ASSIST-3 has been validated across multiple international populations and care environments. It shows strong internal consistency and predictive validity for identifying substance use risk levels and related harms.

  • Scoring guidelines categorize risk levels as:
    • Low: Brief education may be sufficient
    • Moderate: May require brief intervention
    • High: Often indicates a need for intensive treatment
Sources: WHO ASSIST Working Group, 2010; Humeniuk et al., 2008

The Scale

The ASSIST includes 8 core questions per substance class. Topics covered include:

  • Lifetime use
  • Use in the past 3 months
  • Craving
  • Health/social/legal consequences
  • Failed obligations
  • Concern from others
  • Past treatment
Example item: “In the past three months, how often have you had a strong desire or urge to use [substance]?”

Responses are scored and weighted to generate a risk score for each substance.

Score Range

Each substance receives a separate score with three risk categories:

  • Low Risk: Education may be sufficient
  • Moderate Risk: Brief intervention recommended
  • High Risk: Further diagnostic evaluation and referral indicated

Specific score thresholds are defined in the official scoring manual and vary by substance class.

Copyright

© World Health Organization. The ASSIST-3 is part of the WHO Mental Health and Substance Use initiative and is publicly available.

References

  1. WHO ASSIST Working Group. (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for use in primary care. World Health Organization. https://iris.who.int/handle/10665/44320
  2. Humeniuk, R., Ali, R., Babor, T., Souza-Formigoni, M. L. O., de Lacerda, R. B., Ling, W., & Farrell, M. (2008). Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Addiction, 103(6), 1039–1047. https://doi.org/10.1111/j.1360-0443.2007.02114.x

Disclaimer

This summary is for informational use only. HiBoop does not interpret scores or provide clinical advice. The ASSIST-3 should be administered and evaluated by qualified professionals trained in substance use screening.

Permissions

The ASSIST-3 is in the public domain and may be used, adapted, and reproduced for non-commercial purposes with proper attribution to the World Health Organization.

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.