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SCREENING FOR 

DRUG USE IN 

GENERAL MEDICAL 

SETTINGS

Quick Reference Guide
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This guide is designed to assist clinicians serving adult patients in 

screening for drug use. The NIDA Quick Screen was adapted from the 

single-question screen for drug use in primary care by Smith et al. 2010 

(available at http://archinte.ama-assn.org/cgi/reprint/170/13/1155) 

and the National Institute on Alcohol Abuse and Alcoholism’s Helping 

Patients Who Drink Too Much: A Clinician’s Guide Updated 2005 Edition 

(available at http://pubs.niaaa.nih.gov/publications/Practitioner/

CliniciansGuide2005/clinicians_guide.htm). The NIDA-modified ASSIST 

was adapted from the World Health Organization (WHO) Alcohol, 

Smoking and Substance Involvement Screening Test (ASSIST), Version 

3.0, developed and published by WHO (available at http://www.who.int/

substance_abuse/activities/assist_v3_english.pdf). 

This pamphlet is in the public domain and may be reproduced.

Why Screen for Drug Use in General 

Medical Settings?

» Identify drug users early and briefly educate 

them about the adverse consequences of 

continued drug use and available resources 

for quitting

» Enhance medical care by increasing 

awareness of the potential impact of 

substance use on physical health—more 

specifically, the interaction of substance 

use with a patient’s medical care, including 

potentially fatal drug interactions

» Improve linkages between primary and 

secondary health care services and specialty 

drug and alcohol treatment services

How do you screen and provide 

feedback? The Five As:

» Ask

» Advise

» Assess

» Assist

» Arrange
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STEP 1 

Using the NIDA Quick Screen, ask the 

patient about past-year drug use.

In the past year, how many 

times have you used the 

following?

Alcohol (For men, 5 or more 

drinks in a day; for women, 4 

or more drinks in a day)

Tobacco Products

Prescription Drugs for

Nonmedical Reasons

Illegal Drugs

Never

Once or 

Twice

Monthly

Weekly

Daily or

Almost Daily

Patient reports no past-year drug use:

Reinforce abstinence. Screening is complete. 

For more information on use of tobacco

and/or alcohol: Go to page 3.

Patient reports past-year use of illegal

drugs or prescription drugs for

nonmedical reasons: Go to page 4.

Tobacco and Alcohol 

TOBACCO USE

Any current tobacco use places a patient at risk.

Advise all tobacco users to quit.

For more information on smoking cessation, please see “Helping 

Smokers Quit: A Guide for Clinicians” at http://www.ahrq.gov/

clinic/tobacco/clinhlpsmksqt.htm. 

ALCOHOL USE

If the answer is: 

M Never—Advise patient to stay within these limits:

✓ For healthy men under the age of 65:

No more than 4 drinks per day AND no more 

than 14 drinks per week. 

✓ For healthy women under the age of 65:

No more than 3 drinks per day AND no more 

than 7 drinks per week. 

✓ Encourage talking openly about alcohol and any 

concerns it may raise, and rescreen annually. 

M One or more days of heavy drinking

Patient is an at-risk drinker. 

Please see “Helping Patients Who Drink Too Much: A Clinician’s 

Guide” at http://pubs.niaaa.nih.gov/publications/Practitioner/

CliniciansGuide2005/clinicians_guide.htm for information to 

help assess, advise, and assist at-risk drinkers or patients with 

alcohol use disorders.
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STEP 2 

Ask the patient

about lifetime drug use. 

Q1. Which one of the following substances have 

you ever used in your lifetime?

a. Cannabis (marijuana, 

pot, grass, hash, etc.) 

b. Cocaine

(coke, crack, etc.)

c. Prescription

stimulants* (Ritalin,

Concerta, Dexedrine, 

Adderall, diet pills, etc.)

d. Methamphetamine 

(speed, ice, etc.)

e. Inhalants (nitrous, glue, 

gas, paint thinner, etc.)

f. Sedatives or sleeping 

pills* (Valium, Serepax, 

Xanax, etc.) 

g. Hallucinogens (LSD, 

acid, mushrooms, PCP, 

Special K, ecstasy, etc.) 

h. Street opioids

(heroin, opium, etc.)

i. Prescription opioids*

(fentanyl, oxycodone, 

hydrocodone, methadone, buprenorphine, 

etc.) 

j. Other—Specify 

* Please report nonmedical use 

only: Do not record medications 

that are used as prescribed by a 

doctor. 

Patient reports no lifetime

drug use:

Given the patient’s response to the NIDA Quick Screen, 

the patient should not indicate “NONE” for all drugs in 

Question 1. If they do, remind them that their answers 

to the NIDA Quick Screen indicated they used an 

illegal or prescription drug for nonmedical reasons 

within the past year and then repeat Question 1.

If the patient indicates that the drug used is not

listed, please note name of drug next to ‘Other.’ 

If the patient says “Yes” to any of the drugs, proceed 

to next page.
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Ask the following questions for each drug mentioned 

(scores will be tallied at the end)

Patient reports lifetime use 

of one or more substances:

Q2. In the past 3 months, how often have you used each of the 

substances you mentioned [first drug, second drug, etc.]? 0 2 3 4 6

If the answer to Question 2 is “never,” skip to Question 6. 

Otherwise, continue: In the past three months...

Q3. How often have you had a strong desire or urge to use? 0 3 4 5 6

Q4. How often has your use of [first drug, second drug, etc.] 

led to health, social, legal, or financial problems? 0 4 5 6 7

Q5. How often have you failed to do what was normally expected of you because of your use of [first drug, second 

drug, etc.]?

0 5 6 7 8

For each substance ever used (i.e., those mentioned

in the “lifetime” question): NO YES, but not in thepast three months

YES, in the past

three months

Q6. Has a friend or relative or anyone else ever expressed

concern about your use of [first drug, second drug, etc.]? 0 3 6

Q7. Have you ever tried and failed to control, cut down,

or stop using [first drug, second drug, etc.]? 0 3 6

Q8. Have you ever used any drug by injection?

(nonmedical use only)

Recommend HIV/

hepatitis B & C testing

Ask about pattern of 

injecting. Recommend HIV/

hepatitis B & C testing

Never

Once or 

Twice

Monthly

Weekly

Daily or Almost Daily
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Determine risk level 

For each substance (except tobacco and alcohol), 

add up the scores for Questions 2 through 7. To 

determine patient’s risk level and the respective 

recommendations, see below:

STEP 3

✓ Provide feedback on the 

screening results

✓ Advise, Assess, and Assist

✓ Arrange referral

✓ Offer continuing support

High Risk 

Score > 27

Moderate Risk 

Score 4–26

✓ Provide feedback 

✓ Advise, Assess, and Assist

✓ Consider referral based on 

clinical judgment

✓ Offer continuing support

Lower Risk

 Score 0–3

✓ Provide feedback 

✓ Reinforce abstinence

✓ Offer continuing support

STEP 4

Depending on risk level:

Advise—Provide 

medical advice related 

to patient’s drug use.

Assess—Determine 

patient’s readiness

to change.

Assist—Offer help 

based on patient’s 

readiness level.

Arrange—Refer patient 

for specialty assessment 

and/or drug treatment,

if necessary.
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RESOURCES

1. World Health Organization—

The ASSIST Project: Alcohol, 

Smoking and Substance 

Involvement Screening Test

http://www.who.int/

substance_abuse/activities/

assist_v3_english.pdf

2. Substance Abuse and 

Mental Health Services 

Administration SBIRT Web 

site: http://www.samhsa.gov/

prevention/sbirt

3. NIAAA’s Helping Patients 

Who Drink Too Much: A 

Clinician’s Guide:

http://pubs.niaaa.nih.gov/

publications/Practitioner/

CliniciansGuide2005/

clinicians_guide.htm

4. SAMHSA’s Substance

Abuse Treatment Facility 

Locator: http://findtreatment.

samhsa.gov

5. NIDA’s National Drug

Abuse Treatment Clinical 

Trials Network Community 

Treatment Programs: 

http://www.drugabuse.gov/

CTN/ctps.php

6. For Certification in OfficeBased Buprenorphine:

http://buprenorphine.samhsa.

gov/waiver_qualifications.html

7. AHRQ’s Helping Smokers 

Quit: A Guide for Clinicians: 

http://www.ahrq.gov/clinic/

tobacco/clinhlpsmksqt.htm

8. Smith P.C., Schmidt S.M., 

Allensworth-Davies D., 

Saitz R. A Single-Question 

Screening Test for Drug Use 

in Primary Care. Arch Intern 

Med 170:1155–1160, 2010. 

http://archinte.ama-assn.org/

cgi/reprint/170/13/1155

9. Coding for SBI 

Reimbursement:

http://www.samhsa.gov/

prevention/SBIRT/coding.aspx

NOTES
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NOTES

Please visit www.drugabuse.gov/NIDAMED

for an interactive screening tool, screening 

*

resources guide, and additional resources. 
NIH Publication No. 11-7384

Printed April 2009

Revised December 2011