Early Detection of Substance Use: The Role of the ASSIST Screening Test

The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a global screening tool developed by the World Health Organization to detect risky substance use across multiple categories, including alcohol, tobacco, cannabis, and stimulants. It helps providers evaluate addiction risk and tailor treatment. 

In New Jersey, Sussex County reported a chronic heavy drinking rate of 10.2%, nearly double the state average, showing how serious long-term substance use is in local populations. ASSIST screens for lifetime and recent use, urges to use, problems caused, and attempts to quit. 

ASSIST assigns a risk score for each substance and recommends brief interventions or referrals based on the results. Effective in both primary care and behavioral health settings, ASSIST plays a key role in early detection and personalized care planning for addiction recovery.

What Is the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)? 

The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a comprehensive substance use screening tool designed to assess an individual’s involvement with various substances, including alcohol, tobacco, and illicit drugs.

ASSIST is used for addiction risk assessment and early detection of problematic substance use. It helps healthcare providers determine the severity of a patient’s substance use and guide appropriate interventions, including education, counseling, and treatment referrals.

ASSIST is for the following purposes:

• Patients at Risk of Addiction: ASSIST is helpful in addiction risk assessment. It is designed for individuals who are at risk of developing substance use disorders. 
• Primary Care Settings: Physicians and healthcare providers in primary care clinics use ASSIST to screen patients for substance use issues during routine check-ups.
• Mental Health Clinics: Since substance use disorders co-occur with mental health conditions, ASSIST is widely used in psychiatric and behavioral health settings to evaluate patients’ substance use and guide integrated treatment plans.
• Addiction Treatment Programs: Rehabilitation centers and substance use treatment programs frequently employ ASSIST to assess the severity of a patient’s substance use and tailor treatment accordingly.

What Types of Substances Does ASSIST Assess? 

The types of substances that ASSIST assesses are alcohol, tobacco, cannabis, cocaine, opioids, amphetamines, sedatives, hallucinogens, inhalants, and other substances such as club drugs and prescription drugs used for non-medical purposes. According to the National Survey on Drug Use and Health (NSDUH), in 2022, New Jersey reported over 85,000 substance use treatment admissions and nearly as many discharges, highlighting the ongoing demand for addiction services statewide.

The following are the types of substances that ASSIST assesses:

• Alcohol: Alcohol is one of the most commonly used substances. Alcohol misuse leads to liver disease, mental health issues, and dependence. According to the NIAAA, in 2023, 10.2% of Americans aged 12 and older had an alcohol use disorder (AUD).
• Tobacco: Nicotine dependence is a significant public health issue, contributing to lung disease, cancer, and cardiovascular problems. According to the CDC, in 2022, 11.6% of US adults smoked cigarettes, which is about 28.8 million people. 
• Cannabis: While increasingly legalized, cannabis use leads to cognitive impairments, mental health issues, and dependence, particularly in young users. According to NCDAS, approximately half of Americans, some 78 million people, claimed to have used marijuana at some point in their lifetime.
• Cocaine: Cocaine is a powerful stimulant. Its use results in cardiovascular problems, addiction, and mental health disorders. Data reported in the National Household Survey on Drug Abuse indicate that an estimated 27,788,000 U.S. residents aged 12 and older used a form of cocaine at least once in their lifetime.
• Opioids: Opioids include both illicit drugs like heroin and prescription drugs such as oxycodone and fentanyl. Between 2014 and 2019, New Jersey’s overdose risk more than tripled, from 120.5 to 426.8 per 100,000 person-years, underscoring a sharp rise in substance-related harm.
• Amphetamines: Amphetamines include substances like methamphetamine and prescription stimulants used for ADHD. According to the 2022 National Survey on Drug Use and Health (NSDUH), approximately 4 million people reported prescription amphetamine misuse in the U.S., and 1.8 million people had a prescription stimulant use disorder.
• Sedatives: Sedatives include benzodiazepines and other central nervous system depressants, which are addictive and dangerous, especially when combined with other depressants like alcohol. Almost 1 in 10 adults report misuse of sedatives in their lifetime, according to Goodwin RD, Hasin DS. et al. 2022, titled “Sedative use and misuse in the United States.”
• Hallucinogens: Substances like LSD, psilocybin, and PCP alter perception and cognition. According to SAMHSA, the use of hallucinogens among American people ages 12 and over increased from 1.8% (or 4.7 million people) in 2015 to 2.2% (6 million people) in 2019. Of those, 440,000 were between 12 and 17, 2.4 million were between 18 and 25, and 3.1 million were age 26 or over.
• Inhalants: Substances like glue, aerosol sprays, and nitrous oxide are inhalants, which younger individuals abuse. According to a 2020 survey, 2.4 million people in the U.S. ages 12 and older had misused an inhalant in the past year. 
• Other substances: This category includes club drugs (e.g., MDMA), synthetic drugs, and any other substances misused for their psychoactive effects. Screening helps address emerging substance use trends.

What Are the Main Questions of ASSIST?  

The main questions of ASSIST are designed to assess lifetime use, frequency of use, cravings, consequences, and dependence symptoms related to various substances. The questions follow a standardized approach, guiding patients through different aspects of their substance use history and current behaviors.

The main questions of ASSIST are as follows:

• Lifetime Use: “Have you ever used [substance] in your lifetime?” 
• Frequency of Use: “How often have you used [substance] in the past three months?” 
• Cravings: “In the past three months, have you had a strong desire or urge to use [substance]?” 
• Consequences: “Has your substance use caused health, social, legal, or financial problems?” 
• Dependence Symptoms: “Have you ever failed to meet responsibilities, needed larger amounts, or struggled to cut down on [substance] use?” 

How Does the Alcohol, Smoking, and Substance Involvement Screening Test Work?

The Alcohol, Smoking, and Substance Involvement Screening Test works by systematically assessing a person’s substance use patterns through a structured questionnaire. This structured, evidence-based approach ensures early detection of substance use problems and helps guide effective prevention and treatment strategies.

The Alcohol, Smoking, and Substance Involvement Screening Test works in the following way:

1. Administration by a Healthcare Provider: A doctor, nurse, or mental health professional delivers the test in clinical, mental health, or addiction settings through an interview or self-report format.
2. Structured Interview Format: Patients answer a set of questions about lifetime and recent use, cravings, effects, and signs of dependence across substances.
3. Scoring System: Responses are scored based on frequency and severity, categorizing risk as low (education), moderate (brief intervention), or high (treatment referral).
4. Interpretation and Intervention: Providers use scores to recommend appropriate next steps, from education to formal addiction treatment.

How Is the ASSIST Conducted? 

The ASSIST is conducted using a self-report survey or a structured interview with a healthcare professional. Both methods are effective, and the choice depends on the clinical setting, patient preference, and available resources to ensure an accurate addiction risk assessment.

The ASSIST is conducted using the following two methods:

• Self-Report Surveys: Patients independently complete the questionnaire, offering privacy and convenience. However, self-reporting leads to underreporting due to recall bias or reluctance to disclose sensitive information.
• Clinician-Administered Interviews: A healthcare provider guides the patient through the ASSIST in a structured format, improving accuracy but requiring more time and trained staff, which limits use in busy settings.

How Long Does It Take to Complete the ASSIST?

The ASSIST takes 5 to 10 minutes to complete, on average, depending on factors such as the patient’s substance use history, comprehension level, and the method of administration (self-report vs. clinician-administered). Individuals with more complex substance use patterns require additional time for detailed responses, while those with minimal or no substance use complete it more quickly.

How Are ASSIST Scores Interpreted for Addiction Risk? 

The ASSIST scores are interpreted into low, moderate, or high addiction risk, helping healthcare providers determine the level of intervention needed. The total score for each substance guides whether a patient requires education, brief counseling, or specialized treatment to address their substance use.

The ASSIST scores are interpreted as follows:

• Low Risk: An ASSIST score between 0 and 3 for alcohol or 0 and 10 for other substances indicates low risk. This score shows minimal or no substance-related harm. 
• Moderate Risk: An ASSIST score between 4 and 26 for alcohol or 11 and 26 for other substances indicates moderate risk. Individuals in this range benefit from brief intervention or counseling to prevent escalation and address early signs of dependence.
• High Risk: An ASSIST score above 26 for any substance indicates high risk. Those in this category require intensive treatment, specialized addiction care, or rehabilitation programs to manage their substance use effectively.

How Is the ASSIST Applied in Addiction Treatment in New Jersey?

ASSIST is applied in addiction treatment in New Jersey by helping healthcare providers assess substance use severity and develop personalized treatment plans based on a patient’s risk level. It supports early detection, guides care decisions, such as brief counseling or rehab, and tracks progress to adjust treatment as needed. For those struggling with alcohol dependency, evidence-based approaches like alcohol addiction treatment provide specialized care tailored to individual needs.

Can ASSIST Be Used in Schools or Workplaces in New Jersey?

Yes, ASSIST can be used in schools, workplaces, social services, and correctional facilities in New Jersey to identify and address substance use issues beyond healthcare settings. In schools, it helps staff detect early substance use and refer students to appropriate support. 

In workplaces, it’s used in wellness and Employee Assistance Programs (EAPs) to identify employees needing help. Community programs and correctional facilities use ASSIST to screen high-risk populations and connect them with treatment.

In 2022, New Jersey reported 85,266 substance use treatment admissions, underscoring the need for early intervention in non-clinical settings, according to the NJ Department of Human Services. Despite its effectiveness, ASSIST use is limited by staffing shortages and privacy concerns.

What Are the Benefits of Using the ASSIST? 

The benefits of using the ASSIST are early detection, personalized treatment guidance, improved patient outcomes, and alignment with evidence-based addiction treatment models. ASSIST helps healthcare providers implement targeted interventions that enhance treatment effectiveness and reduce relapse rates by systematically assessing substance use risk levels.

The benefits of using the ASSIST are as follows:

• Early Detection of Substance Use Disorders: By identifying substance use patterns before they escalate, ASSIST allows for timely intervention, preventing the progression to severe addiction and reducing long-term health risks.
• Guiding Personalized Treatment Plans: ASSIST tailors treatment recommendations based on a person’s risk level, ensuring that individuals receive the appropriate level of care, whether it’s brief counseling, outpatient support, or intensive rehabilitation.
• Improving Patient Outcomes: Early and accurate assessment leads to better recovery rates, as individuals receive interventions that match their needs, improving their chances of sustained sobriety and overall well-being.
• Aligning with Evidence-Based Addiction Treatment Models: ASSIST integrates seamlessly with proven treatment approaches, such as Cognitive Behavioral Therapy (CBT) and Medication-Assisted Treatment (MAT), ensuring that screening results are linked to scientifically supported recovery strategies.
• Reducing Relapse Rates: By assessing poly-substance use and addiction severity, ASSIST helps identify individuals at high risk of relapse, enabling healthcare providers to implement preventive strategies that support long-term recovery.
• Improving Intervention Effectiveness: Structured screening ensures that resources are directed toward individuals who need them most, enhancing the efficiency of addiction treatment programs and maximizing their impact in clinical and community settings.

What Are the Challenges of Using ASSIST? 

The challenges of using ASSIST are self-report bias, time constraints, patient reluctance, cultural considerations, and limited clinician training in low-resource settings. While ASSIST is a valuable tool for substance use screening, these challenges impact its accuracy and effectiveness, particularly in settings with limited resources and staffing.

The challenges of using ASSIST are as follows:

• Self-Reporting Bias: Individuals underreport substance use due to stigma, fear, or memory gaps, making responses less reliable.
• Time Constraints: Even a 10-minute screening is challenging to implement in busy clinical settings handling multiple assessments.
• Patient Reluctance: Some people are unwilling to discuss their substance use, especially in workplaces or formal interviews.
• Cultural Considerations: Without culturally tailored questions, ASSIST misses substance use patterns in diverse populations.
• Clinician Training in Low-Resource Settings: Accurate use of ASSIST requires trained staff, which many underfunded clinics and rural areas lack.

Who Should Take the ASSIST Screening Test?  

Individuals at risk of substance use or addiction should take the ASSIST screening test. The test helps identify early signs of substance misuse and guides appropriate intervention strategies.

The following individuals should take the ASSIST screening test:

• Patients with a History of Substance Use: Screens for current risk and relapse potential in those with past alcohol, tobacco, or drug use.
• Individuals with Mental Health Conditions: Identifies co-occurring substance use in those with depression, anxiety, PTSD, or other disorders.
• People in High-Risk Environments: Flags early use among individuals exposed to stress, trauma, or peer pressure.
• Patients Seeking Medical or Psychiatric Care: Detects misuse of prescription drugs like opioids or stimulants in clinical settings.
• Adolescents and Young Adults: Identifies early substance use to allow for timely prevention and support.

How Does the ASSIST Compare to Other Alcohol and Drug Screening Tests?

The ASSIST compares to other alcohol and drug screening tests by offering a broader multi-substance screening capability than AUDIT and DAST, which focus primarily on alcohol and drug use, respectively.

While AUDIT (Alcohol Use Disorders Identification Test) is effective for detecting hazardous drinking (with 73.5% sensitivity and 86.1% specificity), ASSIST provides a more comprehensive assessment across multiple substances. 

Similarly, DAST (Drug Abuse Screening Test) focuses solely on drug use but lacks ASSIST’s detailed risk stratification. ASSIST’s strength lies in its ability to assess licit and illicit substances, making it ideal for screening tests in diverse healthcare settings.

How Does ASSIST Compare to the CAGE Questionnaire?

The ASSIST compares to the CAGE Questionnaire by providing a more detailed and comprehensive substance use assessment. While CAGE is a brief, four-question tool focused solely on alcohol use, ASSIST screens for alcohol, tobacco, and multiple drugs. 

The CAGE Questionnaire is quick and helpful in identifying alcohol dependence, but it lacks risk stratification and does not assess drug use. In contrast, ASSIST evaluates substance use severity and guides clinical intervention and treatment planning.

How Does ASSIST Compare to the AUDIT?

The ASSIST compares to the AUDIT by offering broader substance use screening beyond alcohol. While AUDIT is specifically designed to assess hazardous drinking, ASSIST evaluates alcohol use along with tobacco, cannabis, stimulants, opioids, and other drugs. ASSIST’s utility across multiple substances makes it a more versatile screening tool compared to AUDIT’s focus on alcohol use disorders. Clinicians use AUDIT for alcohol-specific concerns, but ASSIST is preferred when a comprehensive addiction risk assessment is needed.