Substance Abuse Evaluation

Substance Abuse Evaluation

[YOUR COMPANY NAME]

Date: [DATE]

This comprehensive evaluation is meticulously structured to assess an individual's substance abuse history, behaviors, and pertinent factors. It aims to gather detailed information regarding substance use patterns, familial background, mental health status, legal entanglements, and treatment regimens methodically.

Evaluation Criteria:

1. Substance Use History:

  • A thorough exploration of the individual's substance use history, encompassing types of substances, frequency, and severity of use.

2. Family History:

  • Assessment of familial history with substance abuse to gauge potential genetic or environmental predispositions.

3. Mental Health History:

  • In-depth evaluation of the individual's mental health status, focusing on any underlying conditions that may influence or exacerbate substance abuse tendencies.

4. Legal Issues:

  • Examination of any legal entanglements directly or indirectly linked to substance abuse, including arrests, convictions, or pending legal matters.

5. Treatment History:

  • Comprehensive overview of past treatment interventions, their efficacy, and current treatment plans, if any.

Evaluation Table:

Criteria

Details

Remarks

Rating

Substance Use History

Types of substances

Frequency of use

Severity of use

Family History

History of substance abuse in the family

Mental Health History

Existing mental health conditions

Legal Issues

Current legal issues related to substance abuse

Treatment History

Past treatment interventions

Efficacy of past treatments

Current treatment plans, if any

Rating Criteria:

  • 1: Very Poor

  • 2: Poor

  • 3: Average

  • 4: Good

  • 5: Excellent

Additional Comments and Notes

Criteria

Notes

Substance Use Pattern

Family History

Mental Health Status

Legal Issues

Treatment History

Evaluation Templates @ Template.net