WIPHL uses the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) as its full screen. For each of nine families of substances, an initial question on lifetime use is asked. For each family of substances a patient has used, six additional questions are asked. Responses suggest which of the five categories the patient falls into with regard to each family of substances:

Abstinence: No drinking, no drug use in the past year.
Recommended clinical response: Reinforcement of healthy behaviors.

Low-risk use: No drug use, and alcohol use that adheres to the National Institute on Alcohol Abuse and Alcoholism's low-risk recommendations:

Men age 64 or less: No more than 14 drinks per week, or 4 drinks per occasion
Women age 64 or less: No more than 7 drinks per week, or 3 drinks per occasion
Men and women ages 65 or more: No more than 7 drinks per week, or 1 drink per occasion
Recommended clinical response: Reinforcement of healthy behaviors.

At-risk use: Use of an illicit drug, or use of alcohol in excess of NIAAA's low-risk recommendations.
Recommended clinical response: Brief intervention.

Abuse: Continued drinking or drug use despite repeated adverse health or social consequences.
Recommended clinical response: Brief intervention.

Dependence: A pattern of substance (alcohol or drug) use where individuals exhibit an inconsistent ability to control their use. The loss of control occurs because of a physiologic abnormality in the part of the brain that is responsible for pleasure and biologic drives. By rewarding animals (including humans) with a sense of pleasure after eating and mating, this part of the brain drives behaviors that promote survival of the individual and the species. After sufficient substance use, especially when there is genetic predisposition, this part of the brain drives substance use behaviors. Other frequent symptoms of alcohol dependence (alcoholism) or drug dependence (addiction) include preoccupation with thoughts of obtaining or using substances, cravings, and compulsive use, meaning that use of a small amount of a substance makes it particularly difficult not to engage in more substance use. Individuals with this pattern of use may or may not have physical dependence, where sudden cessation or reduction of substance use causes stereotypical withdrawal symptoms.
Recommended clinical response: Referral to treatment.


Reference
Humeniuk R. Validation of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and Pilot Brief Intervention: A Technical Report of the Phase II Findings of the WHO ASSIST Project. Geneva, Switzerland: World Health Organization, 2006. From WHO Assist Project.