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This manual is a companion to ‘The ASSIST linked brief intervention for hazardous and harmful substance use: manual for use in primary care’1 and is based on ‘The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Guidelines for Use in Primary Care. Draft Version 1.1 for Field Testing’2 . The purpose of this manual is to introduce the ASSIST and to describe how to use it in health care settings – particularly community based primary health care settings – to identify people who are using substances, so that a brief intervention (or referral) can be provided, as appropriate. The manual will describe: ❙❙ rationale for screening and brief intervention; ❙❙ problems related to substance use; ❙❙ the development and validation of the ASSIST; ❙❙ how to use the ASSIST (administration, scoring and interpretation of scores); ❙❙ motivational interviewing tips to facilitate the process of asking about substance use; ❙❙ how to incorporate ASSIST screening in everyday practice. Additional information is included in the Appendices to the manual: ❙❙ Appendix A includes a copy of the ASSIST questionnaire. ❙❙ Appendix B includes a copy of the ASSIST response card for clients. ❙❙ Appendix C includes a copy of the ASSIST feedback report card for clients. ❙❙ Appendix D includes a copy of the risks of injecting card for clients. ❙❙ Appendix E provides information about how to adapt the ASSIST for other languages and cultures and to take account of the local situation. ❙❙ Appendix F provides answers to the selftesting questions posed in Chapter 11 ‘Good practice in ASSIST questionnaire administration’. ❙❙ Appendix G provides two scripted ASSIST examples for practice in role play. A companion document ‘The ASSIST-linked brief intervention for hazardous and harmful substance use: manual for use in primary care’1 explains how to link the ASSIST to a brief intervention to help clients reduce or stop their substance use.
This manual is a companion to ‘The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care’ 1 and is based on ‘Brief Intervention for Substance Use: Guidelines for Use in Primary Care. Draft Version 1.1 for Field Testing’2 . The purpose of this manual is to explain the theoretical basis and evidence for the effectiveness of brief interventions and to assist primary health care workers in conducting a simple brief intervention for clients whose substance use is putting them at risk. Together with the companion manual 1, this manual presents a comprehensive approach to screening and brief intervention which is tailored to the specific circumstances of primary care and is designed to improve the health of populations and client groups as well as of individuals. This manual describes: ❙❙ the rationale for brief intervention in primary care; ❙❙ a model of behaviour change; ❙❙ the components of brief interventions that work principles of motivational interviewing and essential skills; ❙❙ how to link the ASSIST screening procedure with a brief intervention; ❙❙ how to give feedback to clients; ❙❙ how to conduct brief intervention for people at moderate risk; ❙❙ examples of ASSIST-linked brief interventions; ❙❙ how to help clients who inject drugs; ❙❙ how to address multiple substance use; ❙❙ how to give longer or recurrent interventions. Although the manual is particularly aimed at primary health care workers, it may also be useful for others who work with high-risk clients or clients who are more likely to engage in drug use such as hospital physicians and nurses, midwives and obstetricians, social workers, prison workers and community correction workers.
This video demonstrates an Alcohol Screening and Brief Intervention (SBI) delivered by a primary health care provider during a telehealth follow-up visit with a 16-year-old patient. After sharing negative STD results, the clinician asks permission to review the patient’s substance use questionnaire and explains that the discussion is confidential, supportive, and focused on helping her make informed choices. Using a calm, non-judgmental approach and motivational interviewing techniques, the provider explores the adolescent’s drinking patterns (frequency, type of alcohol, number of drinks per occasion), reasons for drinking (relaxation, socialising, fitting in), and warning signs such as memory lapses and heavy episodic drinking. The clinician provides clear information about the specific risks of alcohol use in adolescence, including effects on brain development, injury risk, sexual assault, and sexually transmitted infections. The conversation connects alcohol use to a recent episode of unprotected sex, helping the patient reflect on how drinking influenced her decision-making. The provider explores ambivalence, assesses readiness to change using a 0–10 scale, and supports the patient in developing a practical plan: limiting intake, tracking drinks, involving a trusted friend for accountability, and committing to condom use and avoiding sex when intoxicated.
This video demonstrates a brief alcohol intervention delivered by a behavioral health team member in a primary care setting following an annual screening. The patient reports drinking daily after work, often consuming four or more beers, with episodes of heavier drinking that lead to embarrassment, guilt, hangovers, and regret. Through open-ended questions and reflective listening, the clinician explores the patient’s drinking pattern, triggers (after-work socialising), and consequences (loss of control, doing embarrassing things, difficulty functioning the next day). Although the patient does not identify as “an alcoholic” and does not experience morning withdrawal symptoms, she expresses concern about repeated episodes of overdrinking and a desire to “drink like other people.” The provider reviews the screening results, explaining that her score places her in the highest risk category on the alcohol risk pyramid, where harmful consequences are more likely and additional support is often recommended. While abstinence is presented as the medical recommendation at this level of risk, the clinician emphasizes patient choice and autonomy. Using a readiness-to-change scale (0–10), the provider elicits motivation for change, including a recent embarrassing episode at a work event and a desire to stop regrettable behaviour. The patient agrees to a facilitated referral to a specialized treatment service for further assessment. The clinician offers to call the intake counselor together before she leaves and schedules a follow-up appointment to maintain support. The video models how SBIRT can progress from brief intervention to referral to treatment (RT), emphasizing empathy, autonomy, and collaborative decision-making when alcohol use is causing significant harm.
This video demonstrates an Alcohol Screening and Brief Intervention (SBI) delivered by a primary care provider to a 60-year-old patient during a visit to review antidepressant medication. As part of routine care, the patient completed the AUDIT screening tool, which identified alcohol consumption above recommended limits. The clinician reviews the screening results in a neutral, non-judgmental manner, clarifying drinking patterns (four or more times per week, typically three drinks per occasion, sometimes finishing a bottle of wine). The provider explains low-risk drinking guidelines for women (no more than seven drinks per week) and discusses health risks associated with higher consumption, including cancer, liver disease, insomnia, and worsening depression. Using motivational interviewing techniques, the provider explores the patient’s reasons for drinking (to relax, cope with low mood, make evenings more enjoyable) alongside concerns (guilt, drinking more than intended, feeling worse afterward). The conversation connects alcohol use with depressive symptoms and highlights how alcohol may interfere with treatment. Through a readiness-to-change scale (0–10), the patient expresses strong motivation to reduce intake. Together, they agree on a realistic harm-reduction goal (reducing to two drinks per night), identify practical strategies (keeping less wine at home), and explore alternative relaxation methods such as reading, watching movies, and taking baths without alcohol. The visit concludes with encouragement and a planned follow-up.
This video presents a lived-experience perspective on substance use and recovery, illustrating how screening and clinician engagement can influence a patient’s path toward treatment. The speaker describes a long history of substance use that began in adulthood with cannabis and cocaine, progressed to methamphetamine, prescription opioid dependence after dental procedures, and eventually heroin use. Alcohol also became a central part of daily life, affecting professional functioning and relationships. Despite serious consequences—including DUIs, escalating substance use, and interpersonal difficulties—the speaker explains that healthcare providers rarely asked directly about alcohol or drug use. Questions focused on symptoms such as anxiety or depression, but substance use itself was never explored. The speaker reflects that being asked directly about substance use or completing a screening questionnaire might have helped initiate earlier recognition of the problem. The narrative highlights several important themes for clinicians: Value of routine screening: Written screening tools can help patients disclose substance use more honestly and allow clinicians to open a supportive conversation. Importance of clinician engagement: Patients may benefit from providers who discuss results, offer feedback, and connect them with treatment resources. Role of prescribing practices: The speaker describes how easy access to opioid prescriptions contributed to dependence and suggests that careful prescribing and limits may reduce risk. Recovery as a process: The speaker notes that mandated treatment was not helpful until they personally chose to engage in treatment. Supportive clinician relationships: A trusting relationship with a physician who understands addiction, responds non-judgmentally to relapse, and celebrates progress has been central to long-term recovery. The video emphasizes a key message for healthcare professionals: asking about substance use—openly and routinely—can open the door to life-saving conversations and support for recovery.
This video demonstrates a brief alcohol intervention delivered by a primary care provider to a 40-year-old patient during a follow-up visit for ADHD management. As part of routine care, the patient completed the AUDIT screening tool, which identified weekend drinking above low-risk guidelines. The clinician reviews the screening results in a respectful, non-judgmental manner, clarifying that the patient typically drinks two to three days per week, consuming five to six (or more) beers per occasion. When the patient questions whether this is “too much,” the provider avoids confrontation and instead explores the patient’s own definition of heavy drinking. The clinician explains national low-risk drinking guidelines for men (no more than 14 drinks per week and no more than four per occasion) and introduces the concept of binge drinking. Short- and long-term health risks are discussed, including injury, impaired driving, cardiovascular disease, cancer, liver disease, and mental health effects. Using motivational interviewing techniques, the provider explores what the patient likes about drinking (taste, social connection, relaxation) and what concerns him (potential health risks). Although the patient is not ready to commit to change, the clinician supports reflection by asking what consequences might prompt reconsideration. The visit concludes with educational materials and agreement to revisit the topic at a future follow-up. The video models how SBI can be integrated into adult primary care, including situations where a patient is ambivalent or resistant, emphasizing respectful dialogue, harm awareness, and ongoing engagement rather than immediate behaviour change.
This training video demonstrates a brief alcohol intervention with an adolescent patient following screening that identified occasional alcohol use and risky situations involving substance use among peers. During the consultation, the physician summarizes the patient’s screening responses, including experimenting with cigarettes, drinking alcohol at parties, and accepting a ride from someone who had been using marijuana. Using a supportive, non-judgmental approach, the physician reinforces positive behaviors (not continuing smoking, avoiding misuse of prescription medications) before focusing on concerns about alcohol use. The discussion explores the patient’s motivations for drinking, such as fitting in socially, while also acknowledging negative experiences, including a blackout and witnessing friends becoming ill after drinking. The clinician provides brief, age-appropriate education about how alcohol affects the developing brain and explains that brain development continues into the early twenties. The physician also highlights the risks associated with blackouts and impaired decision-making during intoxication. Clear guidance is provided that the safest choice for adolescents is not to drink alcohol. Motivation to change is assessed using a readiness scale (0–10), and the patient expresses strong willingness to stop drinking. The conversation also addresses safety behaviors, particularly avoiding riding with drivers who are impaired by alcohol or drugs. Together they identify a practical strategy—contacting parents for a safe ride if needed. The visit concludes with encouragement and a follow-up plan to review progress in the coming months. The video models how brief interventions with adolescents can combine reinforcement of healthy choices, developmentally appropriate risk education, motivational interviewing techniques, and practical safety planning.
This training video demonstrates the screening component of SBIRT with an adolescent patient during a routine clinical visit. After discussing school, sports, and extracurricular activities, the physician transitions to substance use screening and explains confidentiality, reassuring the patient that the conversation will remain private unless there are serious safety concerns. Using a structured and non-judgmental approach, the physician asks a series of screening questions about tobacco, alcohol, marijuana, other drugs, misuse of prescription medications, and risky situations. The patient reports trying a cigarette once, occasional weekend alcohol use at parties after football games, and one instance of riding in a car with someone who had been using marijuana. The patient denies regular drug use but acknowledges that drinking sometimes occurs to fit in socially and reports one episode of memory loss after drinking more than intended (possible blackout). The clinician also asks about common adolescent risk indicators, including: Using alcohol or drugs to relax or fit in Using substances alone Memory lapses related to drinking Concerns expressed by family or friends Trouble at school, home, or with authorities This screening process allows the physician to identify early risk behaviors, including peer influence, social drinking patterns, impaired memory after alcohol use, and riding with an impaired driver. The encounter sets the stage for a brief intervention in the next part of the consultation, where the physician will provide feedback, discuss risks, and support safer decision-making. The video models effective adolescent screening techniques, including building rapport, ensuring confidentiality, asking open and neutral questions, and systematically assessing substance use and related safety risks.
This training video illustrates an ineffective example of a brief intervention with an adolescent patient following screening for alcohol and substance use. The physician confronts the teenager about riding in a car with someone who had used marijuana and about underage drinking. Rather than using a motivational interviewing approach, the clinician adopts a directive and judgmental tone, emphasizing rules, potential consequences, and personal disapproval. The discussion focuses on lecturing the patient about the dangers of driving under the influence and underage drinking, warning about possible accidents and threatening to inform the patient’s parents if the behavior occurs again. The interaction demonstrates several common pitfalls in brief interventions with adolescents: Using judgmental or confrontational language Emphasizing authority rather than collaboration Interrupting the patient’s perspective Failing to explore motivations, context, or ambivalence Not assessing readiness to change or supporting problem-solving As a result, the patient becomes defensive and minimizes the behavior (“it wasn’t that big of a deal”), highlighting how confrontational approaches can reduce openness and engagement. The video is intended as a contrast to effective SBIRT techniques, illustrating why motivational, patient-centered conversations are more effective for discussing alcohol and substance use with adolescents.
This video demonstrates a brief alcohol intervention delivered at a first antenatal appointment with a college student who recently discovered she is over two months pregnant. She reports heavy social drinking prior to learning about the pregnancy (approximately 18 standard drinks per week) and expresses guilt and fear that she may have harmed the baby. She has stopped drinking since finding out but is struggling with the social and emotional adjustment. Using a supportive, non-judgmental approach, the midwife explores pre-pregnancy drinking patterns, acknowledges ambivalence about missing out on college life, and reinforces the patient’s motivation to protect her baby. Clear, evidence-based information is provided about alcohol exposure in pregnancy, including the risk of harm to the developing brain and body. The clinician emphasizes that it is never too late to stop and that abstinence now gives the baby the best possible chance. The conversation highlights internal conflict (social identity vs. motherhood), builds confidence, and identifies peer support as a key protective factor. The patient expresses strong determination to remain alcohol-free and plans to involve close friends for support. The video models how alcohol SBI in antenatal care can address guilt, ambivalence, and social pressure while reinforcing abstinence as the safest choice during pregnancy through empathy, information-sharing, and practical support planning.
This video demonstrates a brief alcohol intervention delivered during a 17-week antenatal appointment. The patient reports drinking small amounts of wine (approximately two to three standard drinks per occasion, three to four nights per week) and believes moderate drinking is acceptable, especially as she drank during a previous pregnancy without apparent harm. Using a respectful, non-confrontational approach, the clinician explores current drinking patterns and asks permission to share updated evidence. The provider explains that current guidance indicates there is no safe amount of alcohol during pregnancy, while also reassuring the patient that small amounts are associated with lower risk than heavier drinking. The conversation acknowledges confusion caused by changing societal messages and normalisation of alcohol use. When the patient becomes defensive and concerned about being judged, the clinician responds with empathy, validates her feelings, and avoids blame. The discussion shifts to practical solutions: protecting time with her husband without alcohol, considering partner support in reducing drinking, and preparing to respond to social pressure from friends and family. The video models how antenatal SBI can address resistance, misinformation, and social norms while clearly communicating that abstinence is the safest option in pregnancy. It demonstrates balancing firm health guidance with reassurance, empathy, and collaborative problem-solving to support behaviour change.
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