CDE Detailed Report
Disease: NeuroRehab
Subdomain Name: Psychiatric and Psychological Status
CRF: Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Displaying 1 - 50 of 80
Subdomain Name: Psychiatric and Psychological Status
CRF: Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)
Displaying 1 - 50 of 80
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C07048 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other substance fail frequency | ASSISTOtherSubFailFreq | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of other substances not previously listed in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of other substances not previously listed 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 failed to do what was normally expected of you because of your use of other-specify | 0;5;6;7;8 | 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07027 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire hallucinogen frequency | ASSISTDsrHallucinogenFreq | Frequency for how often the participant/subject had a strong desire to use 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) | Frequency for how often the participant/subject had a strong desire to use 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 | During the past three months, how often have you had a strong desire or urge to use hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07059 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product fail control indicator | ASSISTTobaccoPrdctFailCntrlInd | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using tobacco products (cigarettes, chewing tobacco, cigars, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using tobacco products (cigarettes, chewing tobacco, cigars, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Have you ever tried and failed to control, cut down, or stop using tobacco products (cigarettes, chewing tobacco, cigars, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07038 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid problem frequency | ASSISTOpioidPrblmFreq | Frequency for how often the participant/subject has used opioids (heroin, morphine, methadone, codeine, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used opioids (heroin, morphine, methadone, codeine, etc.) which led to health, social, legal, or financial problems 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 has your use of opioids (heroin, morphine, methadone, codeine, etc) led to health, social, legal or financial problems? | 0;4;5;6;7 | 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07070 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total a score | ASSISTTotalAScore | Score for the total sum of all the question A scores (tobacco products), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question A scores (tobacco products), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for tobacco products (0-31) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07049 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product concern indicator | ASSISTTobaccoProductConcernInd | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of tobacco products (cigarettes, chewing tobacco, cigars, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of tobacco products (cigarettes, chewing tobacco, cigars, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Has a friend or relative or anyone else ever expressed concern about your use of tobacco products (cigarettes, chewing tobacco, cigars, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07028 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire opioid frequency | ASSISTDsrOpioidFreq | Frequency for how often the participant/subject had a strong desire to use opioids (heroin, morphine, methadone, codeine, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject had a strong desire to use opioids (heroin, morphine, methadone, codeine, 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 opioids (heroin, morphine, methadone, codeine, 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07060 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage fail control indicator | ASSISTAlcohlcBvragFailCntrlInd | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using alcoholic beverages (beer, wine, spirits, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using alcoholic beverages (beer, wine, spirits, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Have you ever tried and failed to control, cut down, or stop using alcoholic beverages (beer, wine, spirits, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07039 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other substance problem frequency | ASSISTOthrSubPrblmFreq | Frequency for how often the participant/subject has used any other substance not previously listed which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used any other substance not previously listed which led to health, social, legal, or financial problems 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 has your use of other - specify led to health, social, legal or financial problems? | 0;4;5;6;7 | 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07071 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total b score | ASSISTTotalBScore | Score for the total sum of all the question B scores (alcoholic beverages), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question B scores (alcoholic beverages), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for alcoholic beverages (0-39) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07050 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage concern indicator | ASSISTAlcoholcBeveragConcrnInd | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of alcoholic beverages (beer, wine, spirits, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of alcoholic beverages (beer, wine, spirits, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Has a friend or relative or anyone else ever expressed concern about your use of alcoholic beverages (beer, wine, spirits, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07029 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire other substance frequency | ASSISTDsrOtherSubFreq | Frequency for how often the participant/subject had a strong desire to use other substances not previously listed in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject had a strong desire to use other substances not previously listed 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 other - specify | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07061 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis fail control indicator | ASSISTCannabisFailCntrlInd | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Have you ever tried and failed to control, cut down, or stop using cannabis (marijuana, pot, grass, hash, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07040 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage fail frequency | ASSISTAlcoholcBeverageFailFreq | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected of you because of your use of alcoholic beverages (beer, wine, spirits, etc)? | 0;5;6;7;8 | 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07072 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total c score | ASSISTTotalCScore | Score for the total sum of all the question C scores (cannabis), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question C scores (cannabis), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for cannabis (0-39) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07051 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis concern indicator | ASSISTCannabisConcernInd | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Has a friend or relative or anyone else ever expressed concern about your use of cannabis (marijuana, pot, grass, hash, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07030 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product problem frequency | ASSISTTobaccoProductPrblmFreq | Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) which led to health, social, legal, or financial problems 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 has your use of tobacco products (cigarettes, chewing tobacco, cigars, etc) led to health, social, legal or financial problems? | 0;4;5;6;7 | 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07062 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine fail control indicator | ASSISTCocaineFailCntrlFreq | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Have you ever tried and failed to control, cut down, or stop using cocaine (coke, crack, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07041 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis fail frequency | ASSISTCannabisFailFreq | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of cannabis (marijuana, pot, grass, hash, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected of you because of your use of cannabis (marijuana, pot, grass, hash, etc)? | 0;5;6;7;8 | 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07073 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total d score | ASSISTTotalDScore | Score for the total sum of all the question D scores (cocaine), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question D scores (cocaine), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for cocaine (0-39) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07052 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine concern indicator | ASSISTCocaineConcernInd | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Has a friend or relative or anyone else ever expressed concern about your use of cocaine (coke, crack, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07031 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage problem frequency | ASSISTAlcohlcBeveragePrblmFreq | Frequency for how often the participant/subject has consumed alcoholic beverages (beer, wine, spirit, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has consumed alcoholic beverages (beer, wine, spirit, etc.) which led to health, social, legal, or financial problems 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 has your use of alcoholic beverages (beer, wine, spirits, etc) led to health, social, legal or financial problems? | 0;4;5;6;7 | 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07063 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant fail control indicator | ASSISTAmphtnTypStmltFlCntrlInd | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Have you ever tried and failed to control, cut down, or stop using amphetamine type stimulants (speed, diet pills, ecstasy, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07042 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine fail frequency | ASSISTCocaineFailFreq | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of cocaine (coke, crack, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected of you because of your use of cocaine (coke, crack, etc)? | 0;5;6;7;8 | 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07074 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total e score | ASSISTTotalEScore | Score for the total sum of all the question E scores (amphetamine type stimulants), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question E scores (amphetamine type stimulants), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for amphetamine type stimulants (0-39) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07053 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant concern indicator | ASSISTAmphtmnTypStmlntCncrnInd | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Has a friend or relative or anyone else ever expressed concern about your use of amphetamine type stimulants (speed, diet pills, ecstasy, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07032 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis problem frequency | ASSISTCannabisPrblmFreq | Frequency for how often the participant/subject has used cannabis (marijuana, pot, grass, hash, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used cannabis (marijuana, pot, grass, hash, etc.) which led to health, social, legal, or financial problems 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 has your use of cannabis (marijuana, pot, grass, hash, etc) led to health, social, legal or financial problems? | 0;4;5;6;7 | 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07064 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Inhalant fail control indicator | ASSISTInhalantFailCntrlInd | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using inhalants (nitrous, glue, petrol, paint thinner, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using inhalants (nitrous, glue, petrol, paint thinner, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Have you ever tried and failed to control, cut down, or stop using inhalants (nitrous, glue, petrol, paint thinner, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07043 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant fail frequency | ASSISTAmphtmnTypStmlntFailFreq | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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) | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected of you because of your use of amphetamine type stimulants (speed, diet pills, ecstasy, etc)? | 0;5;6;7;8 | 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07075 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total f score | ASSISTTotalFScore | Score for the total sum of all the question F scores (inhalants), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question F scores (inhalants), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for inhalants (0-39) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07054 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Inhalant concern indicator | ASSISTInhalantConcernInd | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of inhalants (nitrous, glue, petrol, paint thinner, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of inhalants (nitrous, glue, petrol, paint thinner, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Has a friend or relative or anyone else ever expressed concern about your use of inhalants (nitrous, glue, petrol, paint thinner, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07033 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine problem frequency | ASSISTCocainePrblmFreq | Frequency for how often the participant/subject has used cocaine (coke, crack, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Frequency for how often the participant/subject has used cocaine (coke, crack, etc.) which led to health, social, legal, or financial problems 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 has your use of cocaine (coke, crack, etc) led to health, social, legal or financial problems? | 0;4;5;6;7 | 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07065 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill fail control indicator | ASSISTSedativSlpPillFlCntrlInd | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Have you ever tried and failed to control, cut down, or stop using sedatives or sleeping pills (Valium, Serepax, Rohypnol, etc)? | 0;6;3 | 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months | Numeric Values |
Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1) |
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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| 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) | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07044 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Inhalant fail frequency | ASSISTInhalantFailFreq | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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) | Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 | During the past three months, how often have you failed to do what was normally expected of you because of your use of inhalants (nitrous, glue, petrol, paint thinner, etc)? | 0;5;6;7;8 | 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C07076 | Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total g score | ASSISTTotalGScore | Score for the total sum of all the question G scores (sedatives and sleeping pills), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) | Score for the total sum of all the question G scores (sedatives and sleeping pills), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST | Total score for sedatives (0-39) | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 | No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment | 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 | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-20 10:21:25.65 | Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) | Psychiatric and Psychological Status | Outcomes and End Points |
Single Pre-Defined Value Selected |
