ASK about drug use.

This screening instrument is appropriate for patients age 18 or older. You may deliver it as an interview and record patient responses, or read the Prescreen question aloud and have the patient complete the remaining questions (if applicable) as 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.

A. Introduce yourself and establish rapport.

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 am interested in those only 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.

B. Ask patients about lifetime drug use using the Prescreen Question of the NIDA-Modified ASSIST.

Online Screening Tool

Enter responses and it will automatically lead you to the next appropriate question and tally the scores at the end.

• Without being judgmental or confrontational, ask the patient if he or she has “ever used” any of the substances listed. Note: If the patient mentions a drug not on the list (e.g., steroids), please enter it in the “other” category.
• Be prepared to gently probe certain questions. For example, if the patient answers “No” to every substance, ask a probing question such as “Not even when you were younger, perhaps in high school or college?”
• If the patient says “No” for all drugs in Prescreen, 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.
• If the patient says “Yes” to any of the drugs, go to C.

C. Begin the full NIDA-Modified ASSIST

• For patients who answer “never” to Question 1 (In the past three months, how often have you used the substances you mentioned?): Skip to Questions 5–7 to determine if they have symptoms of a prior substance use problem. Provide feedback (see Step 2) and reinforce abstinence.
• For patients who report use of tobacco: Any tobacco use in the past three months 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 at http://www.ahrq.gov/clinic/tobacco/clinhlpsmksqt.htm.
• For patients who report use of alcohol: Question the patient in more detail about frequency and quantity of use:

If the answer is:

• None: Advise patient to stay within these limits. 
  
  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.
  
  Recommend lower limits or abstinence as medically indicated for patients who:
  • Take medications that interact with alcohol
  • Have a health condition exacerbated by alcohol
  • Are pregnant (advise abstinence).

  Encourage patients to talk openly about alcohol and any concerns that may arise, rescreen annually.

• One or more times of heavy drinking (≥ 5 for men; ≥ 4 for women): Patient is an at-risk drinker.
  
  Please see the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Web site “Helping patients who drink too much: A clinician’s guide” at http://pubs.niaaa.nih.gov/ publications/ Practitioner/Clinicians Guide2005/ clinicians_guide.htm for additional information to Ask, Assess, Advise, Assist, and Arrange help for at-risk drinkers or patients with alcohol use disorders.
• For patients who report any illicit or nonmedical prescription drug use, go to Questions 2 through 7. Note: Ask Question 7 if the patient reports the use of any drug that might be injected, including those that might be listed in the “other” category (e.g., steroids).
• For patients who report alcohol as well as any illicit or nonmedical prescription drug use, ask alcohol follow-up questions and then go to Questions 2–7.

D. Score the full NIDA-Modified ASSIST for illicit and nonmedical prescription drug use

• For each substance, add up the scores received for Questions 1–6. This is the Substance Involvement (SI) score. Do not include the results from either Step 1 (Prescreen) or Question 7 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.

* Screening tool (PDF, 180KB)