• Adapted ASSIST-Lite drug, alcohol and tobacco screening tool for mental health settings

  • Alcohol, Smoking and Substance Involvement Screening Tool Lite (ASSIST-Lite) is an alcohol, tobacco, cannabis, stimulants, sedatives, opioids and psychoactive substances screening tool. It has been modified and licensed for use in health and social care settings in the UK and included in the mental health services dataset.1 There is a version of this tool adapted for health and social care settings. Permission to use this copyrighted tool must be secured by following NHS Digital processes.2

  • Tobacco

  • Alcohol

  • Cannabis

    In the last three months:

  • Stimulants

    In the last three months:

  • 8. Did you use an amphetamine-type stimulant, or cocaine, or a stimulant medication not as prescribed?

    Including, for example, cocaine (powder or crack), crystal methamphetamine, speed and ecstasy/MDMA

  • Sedatives

    In the last three months:

  • 11. Did you use a sedative or sleeping medication not as prescribed including street benzodiazepines?

    Including, for example, diazepam (Valium), flunitrazepam (Rohypnol), temazepam, Z-drugs and street benzodiazepines (for example alprazolam, etizolam and flualprazolam)

  • Opioids

    In the last three months:

  • 14. Did you use a street opioid, or an opioid-containing medication not as prescribed?

    For example, street opioids such as heroin, or opioid-containing medication such as codeine, methadone, buprenorphine, morphine or tramadol.

  • Other substances

    In the last three months:

  • 17. Did you use any other psychoactive substance? (including use of prescribed medications not as prescribed)

    This might include:

    • cathinones (for example mephedrone and ‘Monkey Dust')
    • gabapentinoids (for example gabapentin (Neurontin) and pregabalin (Lyrica)
    • GHB/GBL
    • hallucinogens (for example LSD/acid, mushrooms and DMT)
    • ketamine
    • new psychoactive substances (NPS), such as synthetic cannabinoids (also known as Spice or Mamba)
    • volatile substances such as glue, gas, aerosols or solvents (for example nitrous oxide).

  • Smoking

  • 0 - Non smoker

    No indicated action

  • 1 - Smoker

    Deliver Very Brief Advice (VBA)4 by following these steps:

    • give the patient VBA on smoking
    • actively refer to stop smoking support5 and provide access to stop smoking medications
    • record whether the patient accepted the referral and whether the referral was made

  • Alcohol

    CAUTION: Patients should seek medical advice and specialist assessment before they stop drinking if they have physical withdrawal symptoms (like shaking, sweating or feeling anxious until you have your first drink of the day). It can be dangerous to stop drinking too quickly without proper support.

  • Alcohol 0-4

    Low risk

  • Alcohol 5-7

    Increasing risk

    • deliver alcohol brief advice6
    • if time permits complete remaining Alcohol Use Disorders Identification Test (AUDIT)7 questions (Q4-10) to obtain full AUDIT score and use this score to guide action
    • complete full AUDIT at next review

  • Alcohol 8-10

    Higher risk

    • deliver alcohol brief advice6
    • deliver further assessment within mental health service inclusing remaining (AUDIT)7 questions (Q4-10) to obtain full AUDIT score and use this score to guide action
    • consider treatment intervention in mental health team
    • offer or actively refer for test to diagnose cirrhosis or advanced liver fibrosis
    • complete full AUDIT at next review

  • Alcohol 11-12

    Possible dependence

    • deliver further assessment within mental health service inclusing remaining (AUDIT)7 questions (Q4-10) to obtain full AUDIT score and use this score to guide action
    • consider treatment intervention in mental health team or active referral to a specialist alcohol service8
    • offer or actively refer for test to diagnose cirrhosis or advanced liver fibrosis
    • complete full AUDIT at next review

  • Cannabis

  • 0 - No cannabis use

    No indicated action

  • 1 - Increasing risk

    • deliver cannabis brief advice10 and complete ASSIST-Lite at next review

  • 2 - Higher risk

    • deliver cannabis brief advice10 and complete ASSIST-Lite at next review

  • 3 - High risk

    • deliver further assessment within mental health service
    • consider treatment intervention in mental health team or active referral to a specialist drug service8
    • complete ASSIST-Lite at next review

  • Stimulants

  • 0 - No stimulant use

    No indicated action

  • 1 - Increasing risk

    • Deliver brief advice9 and complete ASSIST-Lite at next review

  • 2 - Higher risk

    Crack cocaine use:

    • deliver further assessment within mental health service
    • consider treatment intervention in mental health team or active referral to a specialist drug service8
    • complete ASSIST-Lite at next review

    Non-crack cocaine use:

    • deliver brief advice9 and complete ASSIST-Lite at next review

  • 3 - High risk

    • deliver further assessment within mental health service
    • consider treatment intervention in mental health team or active referral to a specialist drug service8
    • complete ASSIST-Lite at next review

     

  • Sedatives

    CAUTION: Prescription drugs that may be used not as prescribed should not be stopped suddenly and should only be withdrawn following a comprehensive assessment and with an agreed plan.

  • 0 - No sedative use

    No indicated action

  • 1 - Increasing risk

    • Deliver brief advice9 and complete ASSIST-Lite at next review

  • 2 - Higher risk

    • Deliver brief advice9 and complete ASSIST-Lite at next review

  • 3 - High risk

    • deliver further assessment within mental health service
    • consult with the prescribing agency (misused prescribed medicines) or specialist drug treatment service (illicit drugs or medicines)
    • consider treatment intervention in mental health team or active referral to a specialist drug service8
    • complete ASSIST-Lite at next review

     

  • Opioids

    CAUTION: Stopping opioid use suddenly in an unplanned way increases the risk of unpleasant withdrawals, loss of tolerance and overdose. Opioids should only be withdrawn following a comprehensive assessment and with an agreed plan.

  • 0 - No opioid use

    No indicated action

  • 1 - Increasing risk

    • Deliver brief advice9 and complete ASSIST-Lite at next review

  • 2 - Higher risk

    Street opioid use:

    • deliver further assessment within mental health service
    • consult with the prescribing agency (misused prescribed medicines) or specialist drug treatment service (illicit drugs or medicines)
    • consider active referral into specialist drug service8
    • complete ASSIST-Lite at next review

    Opioid-containing medication misuse:

    • deliver brief advice9 and complete ASSIST-Lite at next review

  • 3 - High risk

    • deliver further assessment within mental health service
    • consult with the prescribing agency (misused prescribed medicines) or specialist drug treatment service (illicit drugs or medicines)
    • consider active referral into specialist drug service8
    • complete ASSIST-Lite at next review

  • Any other psychoactive substance use or prescribed medicines misuse

  • 0 - No other drug use

    No indicated action

  • 1 - Any other drug use

    • deliver brief advice9 and further assessment within mental health service and:
      • where use is low frequency, dose and/or risk, consider treatment intervention in mental health team
      • where use is high frequency, dose and/or risk, consider treatment intervention in mental health team or active referral to a specialist drug treatment service8
    • complete ASSIST-Lite at next review
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  • Should be Empty: