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Compliance and documentation
How to use the Drug Abuse Screening Test (DAST-10) in therapy
A clinician's guide to the DAST-10, including how to score it, choose a defensible cutoff, and document the screen so it supports medical necessity.
October 16, 2026
By Ryan DeCook, LCSW • Clinically reviewed by Bettina D'Andrea, MSN PMHNP-BC
12 min read
By Ryan DeCook, LCSW • Clinically reviewed by Bettina D'Andrea, MSN PMHNP-BC
What to know
1
The DAST-10 is a 10-item screen for self-reported drug-related problems over the past 12 months, excluding alcohol and tobacco. It doesn't diagnose a substance use disorder, but it signals when further assessment may be useful.
2
Score one point for each “yes” response, except item 3, where “no” earns one point. Total scores range from 0–10, but positive-screen thresholds vary by setting, population, and workflow.
3
Document the instrument, completion method, score, interpretation, clinical context, follow-up action, and client response. Clear reasoning, not a score alone, is what connects the screen to medical necessity.
Introduction
As a therapist, if you want a quick, validated read on drug use at intake, the DAST-10 is a great option. It’s only 10 yes or no questions, completed in about five minutes. The challenge is in the details: variable cutoff guidelines, one reverse-scored item that can trip people up, and notes that have to hold up under payer review.
What is the DAST-10?
The Drug Abuse Screening Test (DAST-10) is a 10-item, yes-or-no screening tool that measures drug-related problems over the past 12 months. It excludes alcohol and tobacco, takes about five minutes, and is the short form of the 28-item DAST Harvey Skinner published in 1982.
- Format and length: 10 yes-or-no questions, via self-report or clinician interview, scored 0–10, with yes scores counting as one point each, except one item, which is reverse-scored
- Time window and scope: Problems and consequences from drug use in the past 12 months, not how much or how often someone uses
- What counts as drug use: Non-medical drug use, plus prescription or over-the-counter medication taken beyond directions. Alcohol and tobacco are excluded
- Who it is appropriate for: Adults. For adolescents, use the CRAFFT, S2BI, or DAST-A (Drug Abuse Screening Test–Adolescent)
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The DAST-10 questions
The DAST-10 questionnaire opens with a lengthy preamble. Two parts matter most: Alcohol and tobacco are excluded, and "drug abuse" includes prescription or OTC medication used beyond directions, not only illicit drugs. You can find the 10 yes-or-no questions via the National Library of Medicine.
Clients may minimize or skip items. Note any skipped items, since a partial screen can't be interpreted the same way.
How to score the DAST-10
- Assign points to each response: Award 1 point for every "Yes," except item 3, which is reverse-scored (1 point for "No"). Item 3 is the most common scoring mistake, since it's easy to score a “Yes” there out of habit.
- Sum the total: Add points for a total of 0–10.
- Interpret cautiously: Match the DAST-10 scoring to the severity bands below. The total shows how many drug-related problems the client endorsed. It doesn't show which substance, how much, or whether DSM-5-TR criteria are met.
DAST-10 score interpretation chart
The following scoring ranges follow Skinner's five severity bands.
Skinner framed these bands as tentative guidelines. Read them alongside your clinical interview, observed impairment, and history.
| Score range | Degree of problems | Suggested action |
|---|---|---|
| 0 | No problems reported | None |
| 1–2 | Low level | Monitor or reassess later |
| 3–5 | Moderate level | Further assessment |
| 6–8 | Substantial level | Intensive assessment |
| 9–10 | Severe level | Intensive assessment |
Choosing a cutoff score you can defend
There's no single right cutoff. The most commonly used is ≥3, where the moderate band starts, but published thresholds vary by setting and population. ≥3 performed best as a cutoff in a clinical validation study. Choose based on what a positive screen triggers in your practice.
- Lower threshold (≥3): Use when a positive screen leads to a low-cost next step, like a conversation or fuller assessment, and a missed case costs more than a false positive. You'll catch more cases and accept more false positives.
- Higher threshold: Use when a positive screen commits scarce or high-stakes resources, such as specialty referral or a designation with legal or occupational weight. You'll reduce over-referral and miss more cases.
- Write it into policy: Set the threshold, screening interval, and standard response to a positive screen in your practice's screening protocol.
- Cite it in the chart: Record the cutoff you applied and why (see documentation below).
How to administer the DAST-10 in practice, including telehealth
- Frame it as routine: Tell clients it's a standard screen, not a test they can pass or fail.
- Send it before the session: Deliver it through your secure client portal. If a client is hesitant, or literacy, language, or disability make self-report harder, complete it together as an interview.
- Protect privacy in telehealth: Confirm the client's location and that no one can overhear before reviewing answers. Use a HIPAA-compliant platform and send forms only through encrypted channels.
- Review results: Share results without judgment and at a point where they add to care, often once you have a fuller clinical picture.
- Re-administer: Repeat at intervals that fit your setting to track change over time.
How to document a DAST-10 screen in your notes
- What to record: Date, format (self-report or interview), total score, cutoff applied, notable items, clinical interpretation, action taken, client response, and follow-up plan. If a score meets your cutoff but you don't act on it, document why (for example, use is already addressed in the treatment plan). That reasoning ties the screen to medical necessity, and it's what an auditor looks for.
- Negative screen sample: "DAST-10 completed (past 12 months); score 0/10. Client denied nonmedical drug use and related consequences. No substance-use intervention indicated; will reassess as clinically indicated."
- Borderline screen you chose to monitor sample: "DAST-10 score 2/10 (low). Client reports intermittent cannabis use without loss of control, role impairment, or safety concerns. Reviewed results and harm-reduction considerations; will monitor use and readiness for change at follow-up."
- Positive screen prompting further assessment sample: "DAST-10 score 5/10 (moderate), meeting practice threshold for further assessment. Client reports ongoing cocaine use despite family concern, impaired work performance, and a recent legal issue. Will complete a detailed substance-use and safety assessment next session; next steps added to the treatment plan."
- Storage and attribution: Treat completed forms and scores as PHI under HIPAA safeguards, and retain them per your record-retention requirements. Keep the credit to Harvey A. Skinner and CAMH on any stored or embedded form.
What to do after a positive DAST-10 screen
- Open with curiosity and motivational interviewing: Ask permission, share the score and band neutrally, and connect the client’s use to their own goals. A nonjudgmental motivational interviewing stance is an evidence-based way to raise the topic.
- Move from screen to comprehensive evaluation: Assess against DSM-5-TR criteria: substances, frequency, route, recency, loss of control, withdrawal or overdose risk, functioning, and stage of change. Screen for co-occurring mental health conditions. Coordinate with the client's medical provider when toxicology or medical evaluation is warranted.
- Differentiate response by severity: For low scores, give feedback, harm-reduction education, and monitoring. For moderate scores, do a structured brief intervention and arrange a timely substance-use evaluation. For substantial or severe scores, or any urgent risk (overdose, dangerous withdrawal, intoxication, suicidality), complete a safety assessment right away and facilitate specialty, detox, emergency, or crisis care as indicated.
- Map referrals before you need them: Keep a current list of addiction specialists, inpatient and residential programs, IOP options, peer support, and crisis services. Make warm handoffs when possible, get releases, and document whether the client accepted, declined, or deferred. SAMHSA's National Helpline (1-800-662-4357) offers free, confidential, 24/7 referral information.
DAST-10 vs. other substance use screening tools
- Versus the 28-item DAST: The original gives a more granular severity picture for fuller evaluation or research. The DAST-10 fits a busy intake. Common cutoffs are ≥3 for the DAST-10 and ≥6 for the DAST-28.
- Versus the standard alcohol screener: The DAST-10 excludes alcohol, so pair it with the AUDIT or AUDIT-C to also get a baseline understanding of alcohol use.
- Versus the adolescent screener: Use the CRAFFT, S2BI, or DAST-A with adolescents. SAMHSA lists an adolescent DAST version rather than the DAST-10 for this group.
- Versus opioid and medication misuse tools: The DAST-10 doesn't characterize prescription misuse. TAPS covers tobacco, alcohol, illicit drugs, and nonmedical prescription use. The ORT-OUD assesses opioid-use-disorder risk in adults.
Limitations of the DAST-10 every clinician should know
- Self-report dependency: Clients with a reason to minimize, such as legal, custody, or workplace contexts, may underreport. When stakes are high, add collateral history or coordinate with a medical provider for toxicology testing.
- Measures consequences, not use patterns: Heavy use with few consequences can score low. Ask directly about frequency, quantity, and route.
- Does not distinguish substances: A positive screen doesn't tell you which drug. Follow up with a substance-by-substance inventory.
- Fixed 12-month window: It misses lifetime history and can blur a recent escalation. Ask about earlier use and re-screen over time.
- Not diagnostic: A low score doesn't rule out a problem, and a high one doesn't confirm a disorder. Weigh the score against a full clinical evaluation.
FAQs about the DAST-10
Who developed the DAST-10?
The DAST-10 derives from the Drug Abuse Screening Test developed by Harvey A. Skinner, PhD, at the Addiction Research Foundation in Toronto, now the Centre for Addiction and Mental Health. The original DAST was published in 1982.
Is the DAST-10 free to use?
The DAST is copyrighted by Harvey Skinner and CAMH. The form allows reproduction for non-commercial clinical use with attribution. Commercial, digital-product, or modified use requires permission from CAMH.
How long does the DAST-10 take to administer?
About five minutes, whether the client self-reports or you administer it as an interview.
Does the DAST-10 include alcohol?
No. The DAST-10 excludes alcohol and tobacco. Pair it with an alcohol-specific instrument, such as the AUDIT or shorter AUDIT-C, when alcohol screening is also needed.
What is a high DAST-10 score?
According to the original severity bands, 6–8 indicates a substantial problem and 9–10 a severe problem. Both call for intensive assessment. Level of care, including whether specialty treatment is needed, comes out of that assessment, not the score alone.
Can clients complete the DAST-10 remotely?
Yes. Send it through a secure client portal or administer it by telehealth interview, and confirm the client has privacy before reviewing answers.
Can the DAST-10 diagnose a substance use disorder?
No. It shows whether drug-related problems are likely and whether further assessment is needed. Diagnosis requires a clinical assessment against DSM-5-TR criteria.
Is the DAST-10 valid and reliable?
Yes. A meta-analysis found strong sensitivity (0.90) and good specificity (0.82), meaning it catches most true drug problems while flagging some false positives that need confirmation. Various studies, including this one, confirm that internal consistency and test-retest reliability is good indicating that the instrument measures what it intends to and repeated tests over time measure successfully.
Run screeners like the DAST-10 without the admin drag
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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.
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