CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: Psychological Other
CRF: Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST)

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 / 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
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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07007 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Hallucinogen use indicator ASSISTHallucinogenUseInd Indicator for whether the participant/subject has ever used any hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) 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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

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) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07018 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid use frequency ASSISTOpioidUseFreq Frequency for how often the participant/subject has used opioids (heroin, morphine, methadone, codeine, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used opioids (heroin, morphine, methadone, codeine, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST In the past three months, how often have you used opioids (heroin, morphine, methadone, codeine, etc)? 0;2;3;4;6 0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily Numeric Values

If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07050 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage concern indicator ASSISTAlcoholcBeveragConcrnInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of alcoholic beverages (beer, wine, spirits, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of alcoholic beverages (beer, wine, spirits, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Has a friend or relative or anyone else ever expressed concern about your use of alcoholic beverages (beer, wine, spirits, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07029 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire other substance frequency ASSISTDsrOtherSubFreq Frequency for how often the participant/subject had a strong desire to use other substances not previously listed in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject had a strong desire to use other substances not previously listed in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often have you had a strong desire or urge to use other - specify 0;3;4;5;6 0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07061 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis fail control indicator ASSISTCannabisFailCntrlInd Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Have you ever tried and failed to control, cut down, or stop using cannabis (marijuana, pot, grass, hash, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07008 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Opioid use indicator ASSISTOpioidUseInd Indicator for whether the participant/subject has ever used any opioids (heroin, morphine, methadone, codeine, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether the participant/subject has ever used any opioids (heroin, morphine, methadone, codeine, etc.) for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST In your life, have you ever used opioids (heroin, morphine, methadone, codeine, etc)? 0;3 0-No;3-Yes Numeric Values

BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient's answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: "Not even when you were in school?" If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07040 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage fail frequency ASSISTAlcoholcBeverageFailFreq Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often have you failed to do what was normally expected of you because of your use of alcoholic beverages (beer, wine, spirits, etc)? 0;5;6;7;8 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07072 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total c score ASSISTTotalCScore Score for the total sum of all the question C scores (cannabis), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Score for the total sum of all the question C scores (cannabis), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Total score for cannabis (0-39) 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07019 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other non-medical substance use frequency ASSISTOthrNonmedclSubUseFreq Frequency for how often the participant/subject has used any other substance not for medical use in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used any other substance not for medical use in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST In the past three months, how often have you used other-specify 0;2;3;4;6 0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily Numeric Values

If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07051 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis concern indicator ASSISTCannabisConcernInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cannabis (marijuana, pot, grass, hash, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Has a friend or relative or anyone else ever expressed concern about your use of cannabis (marijuana, pot, grass, hash, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07030 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product problem frequency ASSISTTobaccoProductPrblmFreq Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often has your use of tobacco products (cigarettes, chewing tobacco, cigars, etc) led to health, social, legal or financial problems? 0;4;5;6;7 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07062 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine fail control indicator ASSISTCocaineFailCntrlFreq Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Have you ever tried and failed to control, cut down, or stop using cocaine (coke, crack, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07009 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Other non-medical substance use indicator ASSISTOthrNonmedclSubUseInd Indicator for whether the participant/subject has ever used any other substance not listed for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether the participant/subject has ever used any other substance not listed for non-medical use, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST In your life, have you ever used other - specify 0;3 0-No;3-Yes Numeric Values

BEFORE ASKING QUESTIONS, GIVE ASSIST RESPONSE CARD TO PATIEN.T. If completing follow-up please cross check the patient's answers with the answers given for Q1 at baseline. Any differences on this question should be queried. Probe if all answers are negative: "Not even when you were in school?" If "No" to all items, stop interview. If "Yes" to any of these items, ask Question 2 for each substance ever used.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07041 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cannabis fail frequency ASSISTCannabisFailFreq Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of cannabis (marijuana, pot, grass, hash, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of cannabis (marijuana, pot, grass, hash, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often have you failed to do what was normally expected of you because of your use of cannabis (marijuana, pot, grass, hash, etc)? 0;5;6;7;8 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07073 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total d score ASSISTTotalDScore Score for the total sum of all the question D scores (cocaine), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Score for the total sum of all the question D scores (cocaine), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Total score for cocaine (0-39) 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07020 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire tobacco product frequency ASSISTDsrTobaccoProductFreq Frequency for how often the participant/subject had a strong desire to use tobacco products (cigarettes, chewing tobacco, cigars, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject had a strong desire to use tobacco products (cigarettes, chewing tobacco, cigars, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often have you had a strong desire or urge to use tobacco products (cigarettes, chewing tobacco, cigars, etc)? 0;3;4;5;6 0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07052 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine concern indicator ASSISTCocaineConcernInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of cocaine (coke, crack, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Has a friend or relative or anyone else ever expressed concern about your use of cocaine (coke, crack, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07031 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Alcoholic beverage problem frequency ASSISTAlcohlcBeveragePrblmFreq Frequency for how often the participant/subject has consumed alcoholic beverages (beer, wine, spirit, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has consumed alcoholic beverages (beer, wine, spirit, etc.) which led to health, social, legal, or financial problems in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often has your use of alcoholic beverages (beer, wine, spirits, etc) led to health, social, legal or financial problems? 0;4;5;6;7 0-Never;4-Once or Twice;5-Monthly;6-Weekly;7-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07063 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant fail control indicator ASSISTAmphtnTypStmltFlCntrlInd Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether the participant/subject has ever tried, but failed to control, cut down or stop using amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Have you ever tried and failed to control, cut down, or stop using amphetamine type stimulants (speed, diet pills, ecstasy, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07010 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Tobacco product use frequency ASSISTTobaccoProductUseFreq Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used tobacco products (cigarettes, chewing tobacco, cigars, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST In the past three months, how often have you used tobacco products (cigarettes, chewing tobacco, cigars, etc)? 0;2;3;4;6 0-Never;2-Once or Twice;3-Monthly;4-Weekly;6-Daily or Almost Daily Numeric Values

If "Never" to all items in Question 2, skip to Question 6. If any substances in Question 2 were used in the previous three months, continue with Questions 3, 4 & 5 for each substance used.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07042 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Cocaine fail frequency ASSISTCocaineFailFreq Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of cocaine (coke, crack, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject has used failed to do what was normally expected because of the use of cocaine (coke, crack, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often have you failed to do what was normally expected of you because of your use of cocaine (coke, crack, etc)? 0;5;6;7;8 0-Never;5-Once or Twice;6-Monthly;7-Weekly;8-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07074 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Total e score ASSISTTotalEScore Score for the total sum of all the question E scores (amphetamine type stimulants), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Score for the total sum of all the question E scores (amphetamine type stimulants), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Total score for amphetamine type stimulants (0-39) 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31 No intervention;No intervention;No intervention;No intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;Receive brief intervention;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment;More intensive treatment Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07021 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Desire alcoholic beverage frequency ASSISTDsrAlcoholicBeverageFreq Frequency for how often the participant/subject had a strong desire to consume alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Frequency for how often the participant/subject had a strong desire to consume alcoholic beverages (beer, wine, spirits, etc.) in the past 3 months, as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST During the past three months, how often have you had a strong desire or urge to use alcoholic beverages (beer, wine, spirits, etc)? 0;3;4;5;6 0-Never;3-Once or Twice;4-Monthly;5-Weekly;6-Daily or Almost Daily Numeric Values

Refer to instructions on form.

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

C07053 Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) - Amphetamine type stimulant concern indicator ASSISTAmphtmnTypStmlntCncrnInd Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) Indicator for whether a friend or relative or anyone else has ever expressed concern for the participant/subject's use of amphetamine type stimulants (speed, diet pills, ecstasy, etc), as part of the Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST Has a friend or relative or anyone else ever expressed concern about your use of amphetamine type stimulants (speed, diet pills, ecstasy, etc)? 0;6;3 0-No, Never;6-Yes, in the past 3 months;3-Yes, but not in the past 3 months Numeric Values

Ask Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)

Sue Henry-Edwards, Rachel Humeniuk, Robert Ali, Vladimir Poznyak and Maristela Monteiro. The Alcohol, Smoking and Substance Involvement Screen Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva, World Health Organization, 2003. Adult Supplemental 3.00 2013-07-20 10:21:25.65 Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST) Psychological Other Outcomes and End Points

Single Pre-Defined Value Selected

CSV