ALCOHOL, SMOKING and

SUBSTANCE INVOLVEMENT
SCREENING TEST (ASSIST) linked
BRIEF INTERVENTION (BI)

ERWIN ROMMEL C. LINGAD, RN, MN

NURSE III I HEALTH EDUCATION AND PROMOTION OFFICER (HEPO) DESIGNATE
DEPARTMENT OF HEALTH - TREATMENT AND REHABILITATION CENTER (DOH – TRC)
CAGAYAN DE ORO CITY (CDO)
UPPER PUERTO, CAGAYAN DE ORO CITY
 LEARNING OBJECTIVES

 To know what is WHO ASSIST

BI.
 To appreciate BI.
 To gain confidence in
administering the tool.
 What is ASSIST?

Written by the following researchers: R. Humeniuk,

S. Henry – Edwards, R. Ali, V. Poznyak and M.
Monteiro.
ASSIST – Alcohol, Smoking, and Substance
Involvement Screening Test – was developed
mainly for drug use but can be used for other
substances including alcohol and tobacco,
particularly in high prevalence settings.
It is being considered as an instrument of choice
when the goal is to address a range of different
psychoactive substances.
 What is ASSIST?

ASSIST screens for use of all substances type

(tobacco products, alcohol, cannabis, cocaine,
amphetamine – type stimulants (ATS), sedatives,
hallucinogens, inhalants, sedatives, opioids, and
“other drugs”).
It determines a “risk score” – ‘lower’, ‘moderate’ or
‘high’ for each substance.
 What is BI?

BI – Brief Intervention – is a technique focused

on modifying behaviour of drug users around the
substance used most frequently or the one causing
the most problems for the client (as identified by the
client or highest ASSIST score).
Is a short intervention lasting three (3) to fifteen (15)
minutes given to the client who have been
administered ASSIST.
 What is ASSIST linked BI?

Specifically to designed to be applied to people who

are “moderate risk” from their substance use
according to their ASSIST score and provide them
with a appropriate brief intervention.
“Moderate Risk” are people who are not
dependent but using substances in a hazardous or
harmful way that may be creating health, social,
legal, occupational or financial problems or potential
to create those problems should the substance use.
 What is ASSIST linked BI?

Not intended as a stand-alone treatment for the

people who are dependent or at ‘high risk’ from their
substance use.
However, it should encourage clients to accept a
referral to specialized drug and alcohol assessment
and treatment agency.
The aim of the intervention is to help the client
understand that their substance use is putting them
at risk which may serve as a motivation for them to
reduce or cease their substance use.
STIMULANT/CANNABIS
USE DISORDER

REVIEW
 STIMULANT/CANNABIS USE DISORDER

A pattern of cannabis/amphetamine-type substance, cocaine, or other stimulant use leading

to clinically significant impairment or distress, as manifested by at least two (2) of the
following, occurring within a 12-month period [DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS FIFTH EDITION (DSM-5)]:
1. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the cannabis/stimulant to achieve
intoxication or desired effects.
b. A markedly diminished effect with continued use of the same amount of the
cannabis/stimulant.
2. The cannabis/stimulant is often taken in larger amounts or over a longer period than was
intended.
3. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for cannabis/stimulant.
b. The cannabis/stimulant (or closely related substance) is taken to relieve or avoid
withdrawal symptom.
4. There is a persistent desire or unsuccessful efforts to cut down or control
cannabis/stimulant use.
 STIMULANT/CANNABIS USE DISORDER

A pattern of cannabis/amphetamine-type substance, cocaine, or other stimulant use leading

to clinically significant impairment or distress, as manifested by at least two (2) of the
following, occurring within a 12-month period [DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS FIFTH EDITION (DSM-5)]: :
6. A great deal of time is spent in activities necessary to obtain cannabis/stimulant, use the
cannabis/stimulant, or recover from its effects.
7. Important social, occupational, or recreational activities are given up or reduced because
of cannabis/stimulant use.
8. Recurrent stimulant use in situations in which it is physically hazardous.
9. Cannabis/stimulant use is continued despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to have been caused or exacerbated
by cannabis/stimulant.
10. Recurrent cannabis/stimulant use resulting in a failure to fulfil major role obligations at
work, school, or home.
11. Continued cannabis/stimulant use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of cannabis/stimulant.
 A WALK THROUGH

ALCOHOL, SMOKING, AND SUBSTANCE INVOLVEMENT

SCREENING TEST (ASSIST) TOOL
 QUESTION 1
QUESTION 1: Answerable by a “YES” or
“In your life, which of “NO”.
the following substances To assess which of the
have you ever used?” following substances the
(Non-Medical Use) client used in his lifetime
NOTE: Ask from 0 years without prescription.
old to present age. By asking no. 1, the
interviewer could probe
further to assess
TOLERANCE.
 SUGGESTED TOPIC POINTS?

“Sa imong tibuok kinabuhi, unsa sa

akong ipangutana imong natilawan...
Ang tubag kay “Oo” o “Dili” lang...
Gapanigarilyo? Gainum og beer?
Naka-testing og marijuana? Naka-
testing og shabu? Etc.”
 QUESTION 2
QUESTION 2: To assess the no. of times
“In the past three (3) the substance
months, how often have [FREQUENCY of
you used the substances, DRUG USE] was used
you mentioned (FIRST in the past three (3)
DRUG, SECOND DRUG, ETC.)?” months.
NOTE: Focus for the To assess the substance
LAST THREE (3) he/she is currently using
MONTHS [Screening that is hazardous or
date and backwards]. harmful way.
 SUGGESTED TOPIC POINTS?

“Sa ulahing tulo ka-bulan, kapila sa

imong gitubag na-”Oo” na gamit
nimu... Sagirilyo? Beer? Marijuana?
Shabu? Etc”.
NOTE: Let the client count how many
times [Ipa-ihap kapila sya naka gamit].
 QUESTION 3

QUESTION 3: To assess CRAVING

“In the past three (3) and its SEVERITY
months, how often for the specific
have you had strong substance for the
desire or urge to use past three (3)
(FIRST DRUG, months.
SECOND DRUG, By the interviewers
ETC.)?” probing, to assess
SENSIVITY to
CUES.
 SUGGESTED TOPIC POINTS?

“Sa ulahing tulo ka-bulan, kapila sa

imong gitubag na-natilawan na-ngala
ka o “craving”/gipangita nimu para
makagamit... Sagirilyo? Beer?
Marijuana? Shabu? Etc”.
NOTE: Let the client count how many
times [Ipa-ihap kapila sya naka
nangala].
 QUESTION 4

QUESTION 4: To assess the clients

health associated to
“During the past three
substance use [including
(3) months, how often hospitalizations],
has your use (FIRST FUNCTIONALITY to
DRUG, SECOND the community and
DRUG, ETC.) led to family and behaviour in
health, social, legal or the community because
financial problems?” of intoxication.
 QUESTION 4

QUESTION 4:  Health – physical and mental.

 Social – relationship with
“During the past three partner, family, friends, work
(3) months, how often colleagues.
 Legal – Accidents, contact with
has your use (FIRST law enforcement, driving while
DRUG, SECOND under the influence of a
DRUG, ETC.) led to substance.
 Financial – impact on personal
health, social, legal or budget.
financial problems?”  Occupational – difficulty with
work, study, looking after home
and family.
 Spiritual – feelings of self
worth, guilt, wholeness.
 SUGGESTED TOPIC POINTS?

“Sa ulahing tulo ka-bulan, kapila ka nagkasakit

tungod kay naggamit ka [HEALTH]... Kapila ka
nagkaproblema sa imong communidad
[SOCIAL]... Natawag na ba imong attensyon
tungod sa imong paggamit [LAGAL]... Kapila ka
na-short sa pangkwarta kay nagamit nimu sa
bisyo [FINANCIAL]..”
NOTE: Let the client recall or relate to the
questions. You can choose only one
dimension/domain to ask.
 QUESTION 5
QUESTION 5: To assess
“During the past three impairment in
(3) months, how often
have you failed to do your clients major
what was normally role obligations in
expected of you work, family, etc.
because of your use of
(FIRST DRUG,
SECOND DRUG,
ETC.)?”
 SUGGESTED TOPIC POINTS?

“Sa ulahing tulo ka bulan, tungod ka naa bay

panghitabo na-hubog ka wa ka na-report sa
trabahp?”[Alcohol].
“Sa iulahing tulo ka bulan, naa bay panghitabo, na-
short ka sa imong pangkwarta kay gipalit nimu og
cigarilyo o ilimnon?” [Alcohol & Tobacco].
“Sa ulahing tulo ka bulan, naa bay panghitabo dapat
nimu buhaton pero wa nimu nabuhat kay nagtama ka
o patugpa?” [Shabu etc.].
NOTE: Let the client recall or relate to the questions.
 QUESTION 6
QUESTION 6:  To assess the client’s
behaviour in relation to his
“Has a friend or substance abuse.
relative or anyone  To assess the family’s and
significant others knowledge
else ever expressed of the clients substance abuse.
concern about your  To assess client’s severity of
use of (FIRST using for the past three (3)
months.
DRUG, SECOND  To assess co-dependency in
DRUG, ETC.)?” the family.
 To assess knowledge of ill
effects of drugs.
 SUGGESTED TOPIC POINTS?

“Naa bay kapamilya, amigo o kaila na

nagtambag sa imoha na undangan
ang panigarilyo? Pag-inum og beer?
Paggamit sa marijuana? Paggamit sa
shabu? Etc.”
NOTE: Let the client recall or relate to
the questions.
 QUESTION 7

QUESTION 7: To assess the client’s

desire to stop using the
“Have you ever tried
substance abuse but
and failed, cut down failed to do so in the
or stop using (FIRST past three (3) months
DRUG, SECOND or “slipped” from
DRUG, ETC.)?” recovery or
RELAPSE.
To assess willingness to
change in the past three
(3) months.
 SUGGESTED TOPIC POINTS?

“Naa bay higayon na niundang kag

panigarilyo pero naka balik kag
sirarilyo? Pag-inum og beer?
Paggamit sa marijuana? Paggamit sa
shabu? Etc.”
NOTE: Let the client recall or relate to
the questions.
 QUESTION 8

QUESTION 8: To assess unusual

behaviour in
“Have you ever used
administering the
drug by injection
substance abuse for the
(FIRST DRUG, past three (3) months.
SECOND DRUG, To assess for possible
ETC.)?” diagnosis, treatment
and management, and
referral for Hepatitis B
etc., HIV, and AIDS.
 SUGGESTED TOPIC POINTS?

“Naka-testing ba kag gamit og shabu

na gi-inject nimu?”
NOTE: Let the client recall or relate to
the questions.
RESPOND CARD [ASSIST QUESTION 1]

a. Tobacco product (cigarettes, chewing tobacco, cigars, etc.)

b. Alcoholic (beer, wine, spirits, etc.)
c. Cannabis (marijuana, pot, grass, hash, etc.)
d. Cocaine (coke, crack, etc.)
e. Amphetamine type stimulants (speed, meth, ecstasy, etc.)
f. Inhalants (nitrous, glue, petrol, paint thinner, etc.)
g. Sedatives or Sleeping Pills (Diazepam, Alprazolam,
Flunitrazepam, etc.)
h. Hallucinogens (LSD, acid, mushrooms, trips, Ketamine, etc.)
i. Opioids (heroin, morphine, methadone, codeine, etc.)
j. Others: specify
RESPOND CARD [ASSIST QUESTION 2 - 5]

 NEVER: Not used in the last three (3) months.

 ONCE or TWICE: One (1) to Two (2) times in that last
three (3) months
 MONTHLY: One (1) to three (3) in one (1) month
[Total of 9x in Three (3) Months]
 WEEKLY: One (1) to Four (4) times per week.
[4 x 4 weeks x 3 months = Total 48x in Three (3)
Months]
 DAILY or ALMOST DAILY: Five (5) to Seven (7) days
per week.*
*Assess this, IF denied, proceed to Weekly etc.
RESPOND CARD [ASSIST QUESTION 6 - 8]

 NO, Never
 YES, but not in the past three (3)
months.
 YES, in the past three (3) months.
 ASSIST FEEDBACK REPORT CARD

Total all the score and placed it to the score

card.
Label it as “LOW”, “MODERATE” or “HIGH”
 ASSIST FEEDBACK REPORT CARD

LOW – You are low risk of health and other

problems from your current pattern use.
MODERATE – You are at risk of health and other
problems from your current pattern of substance
use.
HIGH – You are at high risk of experiencing
severe problems (health, social, financial, legal,
relationship) as a result of your current pattern of
use and are likely to be dependents
DISCUSSING FEEDBACK REPORT CARD

LOW – First three (3) related diseases for “low

risk” will be discuss/share to the client.
MODERATE – One (1) to Six (6) relates
diseases for “moderate risk” will be
discuss/share to the client.
HIGH – All related diseases will be
discuss/share to the client.
 RISK OF INJECTED CARD – INFORMATION FOR
PATIENTS

Health Care Provider will discuss/share

to the client that “using substances by
injection increases the risk of harm
from substance abuse”.
 RATIONALE FOR BRIEF INTERVETION IN
PRIMARY CARE

Primary care workers are in unique position

to identify and intervene with clients whose
substance use is hazardous or harmful.
Health promotion and disease prevention
play an important role in the work of
primary care workers – who are often
already engaged in implementing activities
around screening and prevention.
 RATIONALE FOR BRIEF INTERVETION IN
PRIMARY CARE

Clients view primary care workers as a credible

source of advice about health risk including
substance abuse; Eighty five (85%) of the population
worldwide visits primary health care workers.
Primary care workers have the opportunity to
intervene at an early stage before serious substance
related problems and dependence develop.
Primary health care worker can use this link to
introduce screening and brief intervention for
substance use.
 RATIONALE FOR BRIEF INTERVETION IN
PRIMARY CARE

Primary health care worker often have an ongoing

relationship with their clients which enables them
to develop rapport and gain an understanding their
client needs.
Clients generally expect their primary care
clinician to be involved in all aspects of their health
and are likely to feel more comfortable about
discussing sensitive issues such as substance use
etc. to someone they know and trust.
 STEPS ON HOW TO BRIEF INTERVENTION (BI)

 ASKING clients if they are interested in

seeing their questionnaire scores.
 Providing personalised FEEDBACK to
clients about their scores using the ASSIST
feedback report card.
 Giving ADVICE about how to reduce risk
associated with substance use.
STEPS ON HOW TO BRIEF INTERVENTION (BI)

 Allowing clients to take ultimate

RESPONSIBILITY for their choices.
 Asking clients how CONCERNED
they are by their choices.
 Weighing up the GOOD THINGS
about using the substance against the
less good things.
STEPS ON HOW TO BRIEF INTERVENTION (BI)

 LESS GOOD THINGS about using

the substance.
 SUMMARIZE and REFLECT on
clients’ statements about their
substance use with emphasis on the
‘less good things’.
STEPS ON HOW TO BRIEF INTERVENTION (BI)

 Asking clients how

CONCERNED they are by the
‘less good things’.
 Giving clients TAKE HOME
MATERIALS to bolster the
brief intervention.
 TIPS IN ASSIST-linked BRIEF INTERVENTION

 Is objectives.
 Conduit for the delivery of information
pertinent to that client.
 Empathetic and non-judgemental.
 Respects the client’s choices regarding the
decisions they make about their drug use.
 Choices they make during the course of the
brief intervention.
 TIPS IN ASSIST-linked BRIEF INTERVENTION

 Shows the client that they are listening and

not dismissive of the client’s responses.
 Doesn’t argue with client.
 Uses respectful language toward the client
and treats the client as an equal.
 Uses open-ended questions to direct
conversation in the direction of self-discovery
for the client and ultimately towards change.
WHO ASSIST TRAINING
 International Day against Drug Abuse and Illicit Trafficking 2016 Theme

“DAGHANG SALAMAT!