CDE Detailed Report
Disease: content
Subdomain Name: Psychiatric and Psychological Status
CRF: welcome
Displaying 51 - 80 of 80
Subdomain Name: Psychiatric and Psychological Status
CRF: welcome
Displaying 51 - 80 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
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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 | 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 |
