# Situation: The Rural Health Unit (RHU) nurse implements the municipal mental health and substance use program with the barangay health workers (BHWs). At a barangay screening, a 32-year-old man's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores show moderate risk for alcohol and high risk for methamphetamine. He is not intoxicated and has no withdrawal signs. Which level of care should the nurse arrange?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627162  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The Rural Health Unit (RHU) nurse implements the municipal mental health and substance use program with the barangay health workers (BHWs).

At a barangay screening, a 32-year-old man's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores show moderate risk for alcohol and high risk for methamphetamine. He is not intoxicated and has no withdrawal signs. Which level of care should the nurse arrange?

## 보기

1. Brief intervention and enrollment in the community-based program
2. Referral for assessment for residential treatment and rehabilitation **✔ 정답**
3. Community program for alcohol, rescreening the drug use in 3 months
4. Education on drug risks and rescreening at the next barangay visit

**정답: 2**

## 해설

ASSIST gives a risk score for each substance, and the level of care follows the highest risk found. Low risk receives education, moderate risk receives a brief intervention and a community-based program, and high risk or severe disorder is referred to a residential treatment and rehabilitation center. His high-risk methamphetamine score therefore sets the level of care, even though his alcohol score alone would fit the community program.

## 심화 해설

The highest risk sets the level of care
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) gives a separate risk score for each substance a person uses. Each score falls into low, moderate, or high risk. In the Philippine community-based drug rehabilitation framework, the level of care follows the highest risk found across all substances. This man scores moderate risk for alcohol and high risk for methamphetamine. Because one substance is at high risk, he is referred for assessment for residential treatment and rehabilitation, even though his alcohol score alone would fit the community program.

What each risk level calls for
Low risk receives general health education and encouragement to stay at low risk. Moderate risk receives a brief intervention and enrollment in a community-based drug rehabilitation program run with the local government and RHU. High risk, or a likely severe substance use disorder, is referred for further assessment for treatment in a residential treatment and rehabilitation center. He is not intoxicated and has no withdrawal signs, so there is no need for emergency management first, and the nurse can arrange the referral directly.

| ASSIST risk level | Response |
| --- | --- |
| Low | Health education, rescreen as appropriate |
| Moderate | Brief intervention, community-based program |
| High | Referral for residential treatment and rehabilitation |
| This client | Alcohol moderate, methamphetamine high: refer |

Why the other options fall short
Brief intervention with community enrollment is correct for his alcohol score but ignores the more serious methamphetamine risk. Enrolling him for alcohol and rescreening drug use after 3 months delays action on the high-risk problem and leaves it untreated. Education with rescreening at the next barangay visit is the response for low-risk scores, and neither of his scores is low. Watch out! When a client uses several substances, do not average the scores or treat the first substance listed; the highest single risk decides the level of care.

Exam takeaway
Match the response to the highest substance-specific ASSIST risk. While arranging the referral, the nurse can still give brief advice about his alcohol use, explain the referral process and voluntary submission, address fears about arrest, involve his family with his consent, and keep the screening results confidential. Follow-up through the RHU and barangay health workers continues after rehabilitation as part of aftercare and reintegration.

## 임상 시나리오

ASSIST Risk and Level of CareMatching the response to the highest risk
ASSIST gives a risk score for each substance: low, moderate, or high.

Low risk: education. Moderate risk: brief intervention and community-based program. High risk: referral for residential treatment and rehabilitation.

This client's high-risk methamphetamine score sets the level of care, even though his alcohol score is only moderate.

CautionDo not let a lower score on one substance decide the plan when another substance is at high risk.

## 핵심 개념

- **ASSIST** — A WHO screening test that scores risk from each substance a person uses as low, moderate, or high.
- **Brief intervention** — A short, structured counseling session that helps a person reduce risky substance use.
- **Community-based drug rehabilitation** — Outpatient treatment and support for people with moderate-risk drug use, run by local health services.
- **Residential treatment** — Live-in treatment and rehabilitation for people with high-risk or severe substance use.

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