Alcohol‚ Smoking and Substance Involvement Screening Test (ASSIST) V3.0
World Health Organisation [WHO] ASSIST Working Group‚ 2002
آزمون غربالگری درگیری به الکل، دخانیات و مواد مخدر
Question 1
(If completing follow-up please cross check the patient’s answers with the answers given for Q1 baseline. Any differences on this question should be queried)
In your life‚ which of the following substances have you ever used? (NON-MEDICAL USE ONLY)
a. Tobacco products (cigarettes‚ chewing tobacco‚ cigars‚ etc.)
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
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 Question2 for each substance ever used.
Question 2
In the past three months‚ how often have you used the substances you mentioned (FIRST DRUG‚ SECOND DRUG‚ ETC)?
0 = never‚ 2= Once or twice‚ 3=Monthly‚ 4= Weekly‚ 6= Daily or Almost Daily
a. Tobacco products (cigarettes‚ chewing tobacco‚ cigars‚ etc.)
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
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.
Question 3
During the past three months‚ how often have you had a strong desire or urge to use (FIRST DRUG‚ SECOND DRUG‚ ETC)?
0 = never‚ 3= Once or twice‚ 4=Monthly‚ 5= Weekly‚ 6= Daily or Almost Daily
a. Tobacco products (cigarettes‚ chewing tobacco‚ cigars‚ etc.)
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
Question 4
During the past three months‚ how often has your use of (FIRST DRUG‚ SECOND DRUG‚ ETC)? led to health‚ social‚ legal or financial problems?
0 = never‚ 4= Once or twice‚ 5=Monthly‚ 6= Weekly‚ 7= Daily or Almost Daily
a. Tobacco products (cigarettes‚ chewing tobacco‚ cigars‚ etc.)
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
Question 5
During the past three months‚ how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG‚ (FIRST DRUG‚ SECOND DRUG‚ ETC)?
0 = never‚ 5= Once or twice‚ 6=Monthly‚ 7= Weekly‚ 8= Daily or Almost Daily
a. Tobacco products
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
Questions 6 & 7 for all substances ever used (i.e. those endorsed in Question 1)
Question 6
Has a friend or relative or anyone else ever expressed concern about your use of (FIRST DRUG‚ SECOND DRUG‚ ETC)?
0 = No‚ never‚ 6= Yes‚ in the past 3 Months‚ 3= Yes‚ but not in the past 3 Months
a. Tobacco products (cigarettes‚ chewing tobacco‚ cigars‚ etc.)
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
Question 7
Have you ever tried and failed to control‚ cut down or stop using (FIRST DRUG‚ SECOND DRUG‚ ETC)?
0 = No‚ never‚ 6= Yes‚ in the past 3 Months‚ 3= Yes‚ but not in the past 3 Months
a. Tobacco products (cigarettes‚ chewing tobacco‚ cigars‚ etc.)
b. Alcoholic beverages (beer‚ wine‚ spirits‚ etc.)
c. Cannabis (marijuana‚ pot‚ grass‚ hash‚ etc.)
d. Cocaine (coke‚ crack‚ etc.)
e. Amphetamine type stimulants (speed‚ diet pills‚ ecstasy‚ etc.)
f. Inhalants (nitrous‚ glue‚ petrol‚ paint thinner‚ etc.)
g. Sedatives or Sleeping Pills (Valium‚ Serepax‚ Rohypnol‚ etc.)
h. Hallucinogens (LSD‚ acid‚ mushrooms‚ PCP‚ Special K‚ etc.)
i. Opioids (heroin‚ morphine‚ methadone‚ codeine‚ etc.)
j. Other - specify:
Question 7
Have you ever used any drug by injection?
0 = No‚ never‚ 2= Yes‚ in the past 3 Months‚ 1= Yes‚ but not in the past 3 Months
شرح سایت روان سنجی: این ابزار برای اندازه گیری اعتیادهای مشکل آفرین و مخاطره آمیز پدید آمده است.
اعتبار: آلفا درمطالعه " نیکلاس، 2013" آلفا 0.77 گزارش شده است.
چگونگی دستیابی
نمره گذاری
3=YES‚ 0=NO
منبع برای آگاهی بیشتر
WHO ASSIST Working Group. (2002). The Alcohol‚ Smoking and Substance Involvement Screening Test (ASSIST): Development‚ reliability and feasibility. Addiction‚ 97(9)‚ 1183-1194.
Sue Henry-Edwards‚ Rachel Humeniuk‚ Robert Ali‚ Vladimir Poznyak and Maristela Monteiro. The Alcohol‚ Smoking and Substance Involvement Screening Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing). Geneva‚ World Health Organization‚ 2003.
Humeniuk‚ R.‚ Ali‚ R.‚ Babor‚ T. F.‚ Farrell‚ M.‚ Formigoni‚ M. L.‚ Jittiwutikarn‚ J‚.... Simon‚ S. (2008). Validation of the alcohol‚ smoking and substance involvement screening test (ASSIST). Addiction‚ 103(6)‚ 1039-1047
Newcombe‚ D. A.‚ Humeniuk‚ R. E.‚ & Ali‚ R. (2005). Validation of the World Health Organization Alcohol‚ Smoking and Substance Involvement Screening Test (ASSIST): Report of results from the Australian site. Drug and Alcohol Review‚ 24(3)‚ 217-226.
Nicholls. J. D.‚ 2013. The Role of Impulsivity in Co-occurring Social Anxiety and Substance Misuse. Deakin University .Doctor of Psychology thesis. please contact the researchers Dr Nicolas Kambouropoulos (nicolas.kambouropoulos@deakin.edu.au)‚ Associate Professor Petra Staiger (petra.staiger@deakin.edu.au) or Julia Nicholls (jn@deakin.edu.au).