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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Sport Related Concussion
SubDisease: Comprehensive
Sub-Domain: Psychological Other
CRF: Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Item count: 80 (80 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C07000
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product use indicator
ASSISTTobaccoProductUseInd
Indicator for whether the participant/subject has ever used any tobacco products (cigarettes, chewing tobacco, cigars, etc) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used tobacco products (cigarettes, chewing tobacco, cigars, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1a
 
Single Pre-Defined Value Selected
       
C07001
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage indicator
ASSISTAlcoholicBeverageInd
Indicator for whether the participant/subject has ever drank any sort of alcoholic beverages (beer, wine, spirits, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used alcoholic beverages (beer, wine, spirits, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1b
 
Single Pre-Defined Value Selected
       
C07002
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis use indicator
ASSISTCannabisUseInd
Indicator for whether the participant/subject has ever used any cannabis products (marijuana, pot, grass, hash, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used cannabis (marijuana, pot, grass, hash, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1c
 
Single Pre-Defined Value Selected
       
C07003
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine use indicator
ASSISTCocaineUseInd
Indicator for whether the participant/subject has ever used any cocaine products (coke, crack, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used cocaine (coke, crack, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1d
 
Single Pre-Defined Value Selected
       
C07004
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant use indicator
ASSISTAmphtmnTypStmlntUseInd
Indicator for whether the participant/subject has ever used any amphetamine type stimulants (speed, diet pills, ecstasy, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used amphetamine type stimulants (speed, diet pills, ecstasy, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1e
 
Single Pre-Defined Value Selected
       
C07005
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Inhalant use indicator
ASSISTInhalantUseInd
Indicator for whether the participant/subject has ever used any inhalants (nitrous, glue, petrol, paint thinner, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used inhalants (nitrous, glue, petrol, paint thinner, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1f
 
Single Pre-Defined Value Selected
       
C07006
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill indicator
ASSISTSedativeSleepPillInd
Indicator for whether the participant/subject has ever used any sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used sedatives or sleeping pills (valium, serepax, rohypnol, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1g
 
Single Pre-Defined Value Selected
       
C07007
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen use indicator
ASSISTHallucinogenUseInd
Indicator for whether the participant/subject has ever used any hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1h
 
Single Pre-Defined Value Selected
       
C07008
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid use indicator
ASSISTOpioidUseInd
Indicator for whether the participant/subject has ever used any opioids (heroin, morphine, methadone, codeine, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used opioids (heroin, morphine, methadone, codeine, etc)?
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1i
 
Single Pre-Defined Value Selected
       
C07009
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other non-medical substance use indicator
ASSISTOthrNonmedclSubUseInd
Indicator for whether the participant/subject has ever used any other substance not listed for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In your life, have you ever used other - specify
0;3;
0-No;3-Yes;
Numeric Values
BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient’s answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: “Not even when you were in school?” If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q1j
 
Single Pre-Defined Value Selected
       
C07010
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product use frequency
ASSISTTobaccoProductUseFreq
Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used tobacco products (cigarettes, chewing tobacco, cigars, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2a
 
Single Pre-Defined Value Selected
       
C07011
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage frequency
ASSISTAlcoholicBeverageFreq
Frequency for how often the participant/subject has consumed alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used alcoholic beverages (beer, wine, spirits, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2b
 
Single Pre-Defined Value Selected
       
C07012
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis used frequency
ASSISTCannabisUseFreq
Frequency for how often the participant/subject has used cannabis (marijuana, pot, grass, hash, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used cannabis (marijuana, pot, grass, hash, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2c
 
Single Pre-Defined Value Selected
       
C07013
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine use frequency
ASSISTCocaineUseFreq
Frequency for how often the participant/subject has used cocaine (coke, crack, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used cocaine (coke, crack, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2d
 
Single Pre-Defined Value Selected
       
C07014
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant use frequency
ASSISTAmphtmnTypStmlntUseFreq
Frequency for how often the participant/subject has used amphetamine type stimulants (speed, diet pills, ecstasy, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used amphetamine type stimulants (speed, diet pills, ecstasy, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2e
 
Single Pre-Defined Value Selected
       
C07015
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Inhalant use frequency
ASSISTInahalantUseFreq
Frequency for how often the participant/subject has used inhalants (nitrous, glue, petrol, paint thinner, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used inhalants (nitrous, glue, petrol, paint thinner, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2f
 
Single Pre-Defined Value Selected
       
C07016
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill frequency
ASSISTSedativeSleepPillFreq
Frequency for how often the participant/subject has used sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2g
 
Single Pre-Defined Value Selected
       
C07017
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen use frequency
ASSISTHallucinogenUseFreq
Frequency for how often the participant/subject has used hallucinogens (LSD< acid, mushrooms, PCP, Special K, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2h
 
Single Pre-Defined Value Selected
       
C07018
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid use frequency
ASSISTOpioidUseFreq
Frequency for how often the participant/subject has used opioids (heroin, morphine, methadone, codeine, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used opioids (heroin, morphine, methadone, codeine, etc)?
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2i
 
Single Pre-Defined Value Selected
       
C07019
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other non-medical substance use frequency
ASSISTOthrNonmedclSubUseFreq
Frequency for how often the participant/subject has used any other substance not for medical use in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
In the past three months, how often have you used other-specify
0;2;3;4;6;
0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily;
Numeric Values
If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q2j
 
Single Pre-Defined Value Selected
       
C07020
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire tobacco product frequency
ASSISTDsrTobaccoProductFreq
Frequency for how often the participant/subject had a strong desire to use tobacco products (cigarettes, chewing tobacco, cigars, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
During the past three months, how often have you had a strong desire or urge to use tobacco products (cigarettes, chewing tobacco, cigars, etc)?
0;3;4;5;6;
0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily;
Numeric Values
Refer to instructions on form.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q3a
 
Single Pre-Defined Value Selected
       
C07021
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire alcoholic beverage frequency
ASSISTDsrAlcoholicBeverageFreq
Frequency for how often the participant/subject had a strong desire to consume alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
During the past three months, how often have you had a strong desire or urge to use alcoholic beverages (beer, wine, spirits, etc)?
0;3;4;5;6;
0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily;
Numeric Values
Refer to instructions on form.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q3b
 
Single Pre-Defined Value Selected
       
C07022
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire cannabis frequency
ASSISTDsrCannabisFreq
Frequency for how often the participant/subject had a strong desire to use cannabis (marijuana, pot, grass, hash, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
During the past three months, how often have you had a strong desire or urge to use cannabis (marijuana, pot, grass, hash, etc)?
0;3;4;5;6;
0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily;
Numeric Values
Refer to instructions on form.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q3c
 
Single Pre-Defined Value Selected
       
C07023
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire cocaine frequency
ASSISTDsrCocaineFreq
Frequency for how often the participant/subject had a strong desire to use cocaine (coke, crack, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
During the past three months, how often have you had a strong desire or urge to use cocaine (coke, crack, etc)?
0;3;4;5;6;
0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily;
Numeric Values
Refer to instructions on form.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q3d
 
Single Pre-Defined Value Selected
       
C07024
Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire amphetamine type stimulant frequency
ASSISTDsrAmphtmnTypStmlntFreq
Frequency for how often the participant/subject had a strong desire to use amphetamine type stimulants (speed, diet pills, ecstasy, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST).
During the past three months, how often have you had a strong desire or urge to use amphetamine type stimulants (speed, diet pills, ecstasy, etc)?
0;3;4;5;6;
0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily;
Numeric Values
Refer to instructions on form.
Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003.
Adult
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Psychological Other
Outcomes and End Points
ASSIST V3.0 Q3e
 
Single Pre-Defined Value Selected
       
12-19-2018
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