Step 1: ASK about past year drug use
The NIDA Quick Screen and NIDA-modified ASSIST are appropriate for patients age 18 or older. You may deliver it as an interview and record patient responses, or read the questions aloud and have the patient fill out responses on a written questionnaire. It is recommended that the person administering the screening review the sample script to introduce the screening process. The script offers helpful language for introducing what can be a sensitive topic for patients.
Introduce yourself and establish rapport.
Screening Your Patients:
- Ask about past year drug use
- Begin the full NIDA-Modified ASSIST
- Determine risk level
Before you begin the interview, please read the following to the patient:
Hi, I'm __________, nice to meet you. If it's okay with you, I'd like to ask you a few questions that will help me give you better medical care. The questions relate to your experience with alcohol, cigarettes, and other drugs. Some of the substances we'll talk about are prescribed by a doctor (like pain medications). But I will only record those if you have taken them for reasons or in doses other than prescribed. I'll also ask you about illicit or illegal drug use—but only to better diagnose and treat you.
If the patient declines screening, advise the patient that you respect that decision but would like to inform him/her about the potential harms of drug use.
Patients should be advised of the limits of confidentiality and insurance coverage for conditions occurring under the influence of alcohol or illicit drugs (these vary by State and provider).
Ask patients about past year drug use using the NIDA Quick Screen.
- Without being judgmental or confrontational, ask the patient how many times, within the past year, has he or she used any of the substances listed on the NIDA Quick Screen (Online Screening Tool).
- If the patient says "Never" for all drugs in Quick Screen, reinforce abstinence. For example, you may say "It is really good to hear you aren't using drugs. That is a very smart health choice." Screening is complete.
Many people don't know what counts as a standard drink (e.g., 12 oz beer, 5 oz wine, 1.5 oz liquor).
For more information, please see http://pubs.niaaa.nih.gov/publications/practitioner/cliniciansguide2005/clinicians_guide13_p_mats.htm
- For healthy men under the age of 65: No more than 4 drinks per day AND no more than 14 drinks per week.
- For healthy women under the age of 65 and not pregnant (and healthy men over the age of 65): No more than 3 drinks per day AND no more than 7 drinks per week.
If patient answers indicate one or more days of heavy drinking, patient is an at-risk drinker.
- Please see NIAAA website "How to Help Patients Who Drink Too Much: A Clinical Approach" for information on how to Assess, Advise, Assist, and Arrange help for at risk drinkers or patients with alcohol use disorders.
- If patient answers indicate use of tobacco: Any current tobacco use places a patient at risk. Advise all tobacco users to quit. For more information on smoking cessation, please see "Helping Smokers Quit: A Guide for Clinicians".
- If the patient says "Yes" for use of illegal or prescription drugs for nonmedical reasons proceed to Step 2 and begin the NIDA-Modified ASSIST.
Step 2: Begin the NIDA-Modified ASSIST
Ask the patient about lifetime drug use.
If patient reports "No" to lifetime use of all drugs listed in Question 1, remind them that their responses to the NIDA Quick Screen indicate they have used an illegal or prescription drug for nonmedical reasons within the past year. Repeat Question 1.
- If patient indicates that the drug used is not listed, please indicate “Yes” next to other and continue to Question 2.
- If a patient reports "Yes" to lifetime use of substances listed in Question 1, proceed to Question 2, which asks questions about use in the last three months.
- If patient reports "Never" to Question 2 (i.e., no use in the past three months), proceed to Question 6.
- If patient reports use of any drugs in the past three months, complete Questions 3-8.
Step 3: Determine risk level
Score the NIDA-Modified ASSIST for illicit and nonmedical prescription drug use.
Use clinical judgement if the patient reports use of multiple drugs but does not score highly on any of them (i.e., consider an intervention).
- For each substance, add up the scores received for Questions 2–7. This is the Substance Involvement (SI) score. Do not include the results from either Step 1 (Quick Screen), Question 1 or Question 8 in your SI score. The patient will receive an SI score for each substance endorsed, not a cumulative score. Therefore, the patient's risk level may differ from drug to drug.
- Use the resultant SI score to identify patient's risk level. If more than one substance is reported, focus intervention on the substance with the highest score.
As a result of scientific research, we know that addiction is a disease that affects both brain and behavior.