CDE Detailed Report

Disease: Traumatic Brain Injury
Sub-Domain: 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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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) 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 3.00 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

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 Supplemental 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

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 Supplemental 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

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) 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 3.00 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

C07055 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill concern indicator ASSISTSedativSleepPillCncrnInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 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 Supplemental 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

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) 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 3.00 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

C07034 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Inhalant problem frequency ASSISTInahalantPrblmFreq Frequency for how often the participant/subject has used amphetamine type stimulants (speed, diet pills, ecstasy, 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 amphetamine type stimulants (speed, diet pills, ecstasy, 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 amphetamine type stimulants (speed, diet pills, ecstasy, 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 Supplemental 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

C07066 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen fail control indicator ASSISTHallucinogenFailCntrlInd Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 Supplemental 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

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) 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 3.00 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

C07045 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill fail frequency ASSISTSedativSleepPillFailFreq Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected because of the use of 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 During the past three months, how often have you failed to do what was normally expected of you because of your use of sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 Supplemental 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

C07077 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total h score ASSISTTotalHScore Score for the total sum of all the question H scores (hallucinogens), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Score for the total sum of all the question H scores (hallucinogens), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Total score for hallucinogens (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 Supplemental 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

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) 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 3.00 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

C07056 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen concern indicator ASSISTHallucinogenConcernInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 Supplemental 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

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) 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 3.00 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

C07035 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant problem frequency ASSISTAmphtmnTypStmlntPrblmFrq Frequency for how often the participant/subject has used inhalants (nitrous, glue, petrol, paint thinner, 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 inhalants (nitrous, glue, petrol, paint thinner, 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 inhalants (nitrous, glue, petrol, paint thinner, 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 Supplemental 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

C07067 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid fail control indicator ASSISTOpioidFailCntrlInd Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using opioids (heroin, morphine, methadone, codeine, 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 opioids (heroin, morphine, methadone, codeine, 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 opioids (heroin, morphine, methadone, codeine, 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 Supplemental 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

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) 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 3.00 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

C07046 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen fail frequency ASSISTHallucinogenFailFreq Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected because of the use of 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 failed to do what was normally expected of you because of your use of hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 Supplemental 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

C07078 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total I score ASSISTTotalIScore Score for the total sum of all the question I scores (opioids), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Score for the total sum of all the question I scores (opioids), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Total score for opioids (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 Supplemental 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

C07025 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire inhalant frequency ASSISTDsrInhalantFreq Frequency for how often the particpant/subject had a strong desire to use 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 particpant/subject had a strong desire to use 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 had a strong desire or urge to use inhalants (nitrous, glue, petrol, paint thinner, 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 3.00 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

C07057 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid concern indicator ASSISTOpioidConcernInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of opioids (heroin, morphine, methadone, codeine, 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 opioids (heroin, morphine, methadone, codeine, 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 opioids (heroin, morphine, methadone, codeine, 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 Supplemental 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

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) 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 3.00 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

C07036 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Sedative sleep pill problem frequency ASSISTSedativSlepPIllPrblmFreq Frequency for how often the participant/subject has used sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 Supplemental 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

C07068 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other substance fail control indicator ASSISTOtherSubFailCntrlInd Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using other substances that was not previously listed before, 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 other substances that was not previously listed before, 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 other - specify 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 Supplemental 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

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) 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 3.00 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

C07047 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid fail frequency ASSISTOpioidFailFreq Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of 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 failed to do what was normally expected because of the use of 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 failed to do what was normally expected of you because of your use of opioids (heroin, morphine, methadone, codeine, 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 Supplemental 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

C07079 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total j score ASSISTTotalJScore Score for the total sum of all the question J scores (other substances), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Score for the total sum of all the question J scores (other substances), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Total score for other (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 Supplemental 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

C07026 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire sedative sleep pill frequency ASSISTDsrSedativeSleepPillFreq Frequency for how often the particpant/subject had a strong desire to use sedative 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 particpant/subject had a strong desire to use sedative 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 During the past three months, how often have you had a strong desire or urge to use sedatives or sleeping pills (Valium, Serepax, Rohypnol, 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 3.00 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

C07058 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other substance concern indicator ASSISTOtherSubConcernInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of other substances not previously listed before, 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 other substances not previously listed before, 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 other - specify 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 Supplemental 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

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) 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 3.00 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

C07037 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen problem frequency ASSISTHallucinogenPrblmFreq Frequency for how often the participant/subject has used hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 hallucinogens (LSD, acid, mushrooms, PCP, Special K, 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 Supplemental 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

C07069 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Drug by injection indicator ASSISTDrugByInjectionInd Indicator for whether the participant/subject has ever taken a drug via injection before, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether the participant/subject has ever taken a drug via injection before, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Have you ever used any drug by injection? 0;2;1 0-No, Never;2-Yes, in the past 3 months;1-Yes, but not in the past 3 months 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 3.00 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

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 Supplemental 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

CSV