NM ASSIST – Clinician One-Pager
Quick score sheet, SI risk bands, brief intervention prompts, and referral guide. Private. Printable.
Use after a positive NIDA Quick Screen for drugs. SI score per substance uses Q2–Q7. Bands: 0–3 lower, 4–26 moderate, 27+ high. Q8 injection is reported separately.
Step 1. Select substances to score
Tick only those with lifetime use. You can type a custom one.
Step 2. Q2–Q7 frequency and concern
Time frame for Q2–Q5 is past 3 months. Q6 concern and Q7 failed attempts are ever and past 3 months.
| Substance | Q2 use | Q3 urge | Q4 problems | Q5 role fail | Q6 concern | Q7 failed stop | SI score | Risk |
|---|
Step 3. Brief intervention and plan
Lower risk (SI 0–3)
- Reinforce healthy choices.
- Provide information on risks and safer use.
- Agree on monitoring and repeat screen if needed.
Moderate risk (SI 4–26)
- Brief intervention with feedback. Ask – Provide – Ask.
- Explore importance and confidence. Set a concrete change step.
- Offer supports and follow up.
High risk (SI 27+)
- Discuss specialist assessment and referral.
- Consider medication assisted treatment when appropriate.
- Address safety and overdose risk. Provide harm reduction.
Motivational interviewing quick prompts
- Ask open questions. Reflect and summarize.
- Affirm strengths. Elicit change talk.
- Plan one next step. Example: pick a quit date or set limits.
Referral and red flags
- High SI score, recurrent overdoses, withdrawal, or medical complications.
- Injection use, pregnancy, polysubstance use, or safety risks at home or work.
- Co-occurring severe depression, psychosis, or suicide risk. Use local emergency services if unsafe.
Tools you can share from PsychKit™
Checklist
Helpline numbers
If anyone is in immediate danger, contact local emergency services.
India: Tele-MANAS 14416.
USA: 988 Suicide and Crisis Lifeline. Call or text 988.
Canada: 988 Suicide Crisis Helpline. Call or text 988.
UK: Samaritans 116 123.
Ireland: Samaritans 116 123.
Germany: TelefonSeelsorge 0800 111 0 111 or 0800 111 0 222. 116 123 also works.
Australia: Lifeline 13 11 14.
New Zealand: 1737. Call or text 1737.
Singapore: Samaritans of Singapore 1767. CareText WhatsApp 9151 1767.
UAE: Mental Support Line 800 4673. Emergencies call 999.
Russia: Child, teen, parent helpline 8 800 2000 122.
China: Beijing Suicide Research and Prevention Center 800 810 1117 or 010 8295 1332. Lifeline 400 821 1215.
South Africa: SADAG Suicide Crisis 0800 567 567.
Numbers may change. Verify locally. More countries: Get Support
References and credits
- NIDA-Modified ASSIST V2.0 stems and scoring tables. Public domain NIDA resource adapted from WHO ASSIST. No WHO endorsement implied.
- Risk bands used here: 0–3 lower, 4–26 moderate, 27+ high for SI score per substance.