WHO ASSIST V3.0
WHO ASSIST V3.0 overview
Creator and Context
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is the World Health Organization's screening instrument for risky and harmful substance use.
It was developed by the WHO ASSIST Working Group, first published in 2002, with version 3.0 and the primary care manual published in 2010. It screens across ten substance classes in one pass and links directly to a brief intervention.
WHO holds copyright. Commercial reuse and embedding require permission from WHO.
Presenting Conditions
The ASSIST covers ten substance classes: tobacco, alcohol, cannabis, cocaine, amphetamine type stimulants, inhalants, sedatives and sleeping pills, hallucinogens, opioids, and other drugs.
For each substance it asks about frequency of use, craving, health, social, legal and financial problems, failure to meet expectations, concern expressed by others, and failed attempts to cut down. A separate question covers lifetime injecting drug use.
Administration
Eight questions, typically interviewer administered, taking around 5 to 10 minutes. A self administered version also exists. Questions about current use refer to the past 3 months. Questions about lifetime use and problems distinguish between the past 3 months and earlier.
Desired Audience
Adults in primary care and drug treatment settings. Performance differs in adolescents, and separate adolescent validation exists, so the adult risk bands should not simply be transferred.
The ASSIST does not just detect risk, it sorts people into what should happen next: no intervention, a brief intervention, or referral for more intensive treatment. That is why it has been adopted so widely in primary care. It is a screening instrument with a pathway attached.
Considerations
It is a risk stratification screen, not a diagnostic instrument. The bands allocate people to interventions, they do not establish a substance use disorder.
The injecting question is scored separately and is not part of the substance involvement score.
For tobacco, one of the questions is not scored, so the tobacco calculation differs from the others.
Alcohol uses a different moderate risk threshold from every other substance. Applying one threshold across the board will misclassify alcohol use.
WHO holds copyright. Embedding the ASSIST in a commercial product should be treated as requiring WHO permission.
How to score the WHO ASSIST V3.0
Conducting the assessment
The person is asked about lifetime use of each substance. Where use is reported, the remaining questions are asked for that substance. A substance specific involvement score is calculated for each substance separately.
Interpretation
A substance specific involvement score is produced for each substance, with a maximum of 39.
Risk bands for all substances except alcohol:
0 to 3 low risk, no intervention
4 to 26 moderate risk, brief intervention
27 or above high risk, more intensive treatment
Alcohol uses different thresholds:
0 to 10 low risk
11 to 26 moderate risk
27 or above high risk
Injecting drug use is assessed separately and triggers its own intervention pathway.
Clinical Considerations
Apply the alcohol thresholds separately. This is the single most common ASSIST implementation error.
Use the score to drive the intervention, not to label the person. The instrument exists to trigger a conversation.
Screen across all substances rather than only the presenting one. Polysubstance use is the norm, not the exception.
WHO ASSIST V3.0 use cases
Screening for risky and harmful use across ten substance classes
Allocating people to brief intervention or to more intensive treatment
Primary care and integrated care settings
Research and service level reporting
Category
Drug & Alcohol
Research Summary
WHO ASSIST Working Group. (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility. Addiction, 97(9), 1183 to 1194.
Humeniuk, R., Ali, R., Babor, T. F., et al. (2008). Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Addiction, 103(6), 1039 to 1047.
World Health Organization. (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for use in primary care. Geneva: WHO.
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