Substance Use Risk Assessment in Ghana

Substance use risk levels were assessed using the ASSIST version 3.0, a tool to identify levels of risky substance use and related health risks [35 ]. The ASSIST consists of eight questions on lifetime and past three-month use of nine substances: tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives, hallucinogens, and opioids. For each substance used in the last three months, further questions assess the following: 1) frequency of use, 2) urges to use, 3) health, social, legal, or financial problems, 4) and interference with role responsibilities. The ASSIST also queries failed attempts to reduce substance use and whether someone ever expressed concern about use; a follow-up question determines if this occurred in the past three months or more than three months ago [7 (link), 35 ].
A Specific Substance Involvement (SSI) score was calculated for each substance (range: 0–39, same for total scale) using standard ASSIST scoring procedures. Individual SSI scores were categorised into three risk levels: low, moderate, high (Table 1) [13 ]. An overall substance use risk variable was defined based on the highest risk level assigned for any substance.
The WHO-ASSIST has a test–retest reliability coefficient as high as 0.90 [36 (link)]. Although not used in any prior study in Ghana, the instrument has been used and validated with the sub-Saharan African countries like Nigeria, reporting internal correlation coefficients of greater than 0.7 [37 ].