Screening for 

Drug uSe in 

general MeDical 

SettingS 

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

screening for drug use. This screening tool 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 A’s:

» ask » assist

» advise » arrange

» assess
3

SteP 1 

Ask the patient 

about past drug use. 

Which of the following substances have 

you used in	your	lifetime?

a. tobacco products

(cigarettes, chewing 

tobacco, cigars, etc.)

b. alcoholic beverages

(beer, wine, liquor, etc.) 

c. cannabis (marijuana, 

pot, grass, hash, etc.) 

d. cocaine

(coke, crack, etc.) 

e. Prescription

stimulants* (Ritalin,

Concerta, Dexedrine, 

Adderall, diet pills, etc.) 

f. Methamphetamine 

(speed, ice, etc.)

g. inhalants (nitrous, glue, 

gas, paint thinner, etc.) 

h. Sedatives or sleeping 

pills (Valium, Serepax, 

Xanax, etc.) 

i. Hallucinogens (LSD, 

acid, mushrooms, PCP, 

Special K, ecstasy, etc.) 

j. Street opioids

(heroin, opium, etc.) 

k. Prescription opioids*

(fentanyl, oxycodone, 

hydrocodone, methadone, buprenorphine, 

etc.)

l. other—Specify 

*	 Please	report	nonmedical	

use	only:	do	not	record	

medications	that	are	used	as	

prescribed	by	a	doctor.	

*

Please visit www.drugabuse.gov/niDaMeD 

for a complete screening resource guide, 

interactive screening tool, a PDF download 

of the complete screening tool, and 

additional resources. 

Patient reports no lifetime drug use: 

Reinforce abstinence. Screening is complete.
4 5

Patient reports lifetime use of one 

or more substances: 
6 7

M

For any frequency of use	in	the	past	3	months:

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

Question the patient in more detail about frequency 

and quantity of use:

How many times in the past year have you had: 

none—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. 

one or more times 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.
8 9

SteP 2 

Determine risk level 

For each substance (except tobacco and alcohol), 

add up the scores for questions 1 through 6. To 

determine patient’s risk level and the respective 

recommendations, see below:

✓ Provide feedback on the 

screening results High risk ✓ advise, assess, and assist

Score	>	27 ✓ arrange referral

✓ Offer continuing support

✓ Provide feedback 

✓ advise, assess, and assist Moderate risk ✓ Consider referral based on Score 4–26 clinical judgment

✓ Offer continuing support

✓ Provide feedback 

lower risk ✓ Reinforce abstinence

 Score 0–3 ✓ Offer continuing support
RESOURCES

1.	 NIDAMED:	http://www.

drugabuse.gov/NIDAMED

2.	 World	Health	Organization—

The	ASSIST	Project:	

http://www.who.int/

substance_abuse/activities/ 

assist/en/index.html

3.	 Substance	Abuse	and	

Mental	Health	Services	

Administration	SBIRT	Web	

site:	http://sbirt.samhsa.gov/

index.htm 

4.	 NIAAA’s	Helping Patients 

Who Drink Too Much: A 

Clinician’s Guide:	

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

publications/Practitioner/

CliniciansGuide2005/

clinicians_guide.htm

5.	 SAMHSA’s	Treatment	

Facility	Locator:		

http://dasis3.samhsa.gov 

6.	 NIDA’s	National	Drug	

Abuse	Treatment	Clinical	

Trials	Network	List	of	

Associated	Community	

Treatment	Programs:		

http://www.drugabuse.gov/

CTN/ctps.html

7.	 AHRQ’s	Helping Smokers 

Quit: A Guide for Clinicians:	

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

tobacco/clinhlpsmksqt.htm

NIH Publication No. 09-7384

Printed April 2009

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health