CDE Detailed Report

Disease: Sport Related Concussion
Subdomain Name: 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 / 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
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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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

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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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 Exploratory 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