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[DOCX File]TREATMENT PLAN GOALS & OBJECTIVES
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Alcohol/Drugs and Other Addictions. Goal: Be free of drug/alcohol use/abuse. Avoid people, places and situations where temptation might be overwhelming. Explore dynamics relating to being the [child/husband/wife] of an [alcoholic/addict] and discuss them each week at support group meetings. Learn five triggers for alcohol & drug use
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[DOCX File]Child Adolescent Diagnostic Assessment.cdr
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Clinical Interview and Assessment Page 13 of 13 . CLINICAL . INTERVIEW AND ASSESSMENT. Client Name (First, MI, Last) MaGIK; No. Presenting Problem. Date of A. ssessment ... Alcohol/Drug History. Illegal drug use/abuse past 12 months? No. Yes.
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[DOC File]DRUG AND ALCOHOL QUESTIONNAIRE - clarkclipsonphd
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Title: DRUG AND ALCOHOL QUESTIONNAIRE Author: Clark R. Clipson, Ph.D. Last modified by: Clark Clipson, Ph.D. Created Date: 2/19/2003 11:39:00 PM Other titles
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[DOC File]Case Management Assessment Form
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Apr 27, 2010 · Case Management Assessment Tool. General: Agency ID #: Date of Assessment: _____ ... Counseling Burial Assistance Case Management Care Teams Clothing Dental Care Continuing education Drug/Alcohol Treatment Domestic Violence Food Assistance Emergency Shelter Food Stamps Employment Legal Assistance HIV Education Medical- HIV Specialty …
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[DOCX File]FULL ASAM ASSESSMENT - ADULT
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Amy has a 5 yr history of opioid use, beginning with prescription opioids and progressing to mixed prescription and heroin use. She has attempted multiple programs to try and manage her use and despite these attempts and escalating harmful consequences (loss of employment and independent housing), she continues to use.
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[DOC File]SAMPLE ADULT CD ASSESSMENT - Washington State
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Feb 29, 2008 · relapse/continued use potential insert drug/alcohol history data collection here. COMPLETE A COMPREHENSIVE FACE-TO-FACE DIAGNOSTIC INTERVIEW TO OBTAIN, REVIEW, EVALUATE, AND DOCUMENT A HISTORY OF THE PATIENT’S INVOLVEMENT WITH ALCOHOL AND OTHER DRUGS, INCLUDING TYPE OF SUBSTANCE, ROUTE OF …
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[DOC File]Data Assessment Plan (DAP) Note - Rutgers University
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Data Assessment Plan (DAP) Note. CLIENT/ID: Date: Counselor’s Initials: A DAP note is to be filled out each time you meet with a client for a CLEAR session. Please use the questions and statements listed below each section as a guide to what information needs to be included in order to ensure that this note is a complete explanation of the ...
drug and alcohol assessment questionnaire

[DOC File]NJSAMS - Home
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hospital because of alcohol and drug problems? nights. In the past 30 days, how many times were you treated for . alcohol or drug problems: in an emergency room? times. as an outpatient? (In a doctor or clinic office) times. In the past 30 days, to what extent has your use of alcohol. or other drugs caused you to reduce or give up important ...
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[DOC File]RELAPSE PREVENTION PLAN WORKSHEET
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RELAPSE PREVENTION PLAN WORKSHEET. DRUGS. A relapse prevention plan is a tool to help you as you continue your life free from drugs. The following questions will help you examine your past behavior and how you overcame your dependence on drugs.
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[DOC File]SMART TAP Assessment - Maryland
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Arson? 12. Rape? 13. Homicide/manslaughter? 14. Prostitution? 15. Contempt of court? 16. Driving While Intoxicated past 12 months? 17. Non-drug or alcohol-related crime while under the influence in the last 12 months? 18. Non-drug or alcohol-related crime while not under the influence in the last 12 months? 19. Drug or alcohol-related crime in ...
drug and alcohol survey questionnaires

Printable alcohol and drug assessment