Substance Abuse Risk Assessment

Welcome to the Substance Abuse Risk Assessment. This confidential evaluation aims to explore various aspects of your life to better understand potential risk factors and tailor support for your well-being. Your honesty is crucial for accurate assessment and guidance.

Personal Information:

Full Name:	[Your Name]
Date of Birth:	[Month Day, Year]
Gender:	[Your Gender]
Contact Information:	[Your Contact Information]
Emergency Contact:	[Name, Contact Information]

Demographic Information:

Marital Status:	[Your Name]
Living Arrangements:	[Renting an apartment]
Educational Background:	[Bachelor's degree in Business Administration]
Employment Status:	[Full-time employment]

Family History

Family Substance Abuse History:	[Father had a history of alcohol abuse]
Family Mental Health History:	[No known history]

Personal Substance Use History

Substance	Age of First Use	Frequency	Current Pattern	Previous Attempts to Quit/Cut Down
[Alcohol]	[18]	[Weekly]	[Social drinking]	[No]

Medical History

Current physical health status:	[Generally good]
Medications and medical conditions:	[No chronic medications, no significant medical conditions]
History of chronic pain or illness:	[None reported]

Mental Health Assessment

Presence of mental health disorders or symptoms:	[No formal diagnosis; occasional anxiety]
History of trauma or significant life stressors:	[No reported history]
Coping mechanisms and strategies:	[Exercise, occasional journaling]

Psychosocial Factors

Current living situation:	[Renting an apartment alone]
Support system:	[Limited family support; a few close friends]
Financial stressors:	[Moderate financial stress due to student loans]

Environmental Influences

Peer influences:	[Some friends engage in substance use]
Access to substances:	[Easy access to alcohol and marijuana]
Workplace or school environment:	[Supportive work environment]

Motivation and Readiness for Change

Willingness to make changes:	[Open to change; expresses desire to cut down on substance use]
Previous attempts at change:	[Attempted to quit marijuana without success]
External motivation factors:	[Concerns about impact on job performance]

Behavioral Observations

A. Observable signs of substance use: None reported by the individual

B. Impairments in daily functioning: No significant impairments reported

Screening Tools

A. Results of standardized screening tools/questionnaires:

Completed AUDIT (Alcohol Use Disorders Identification Test); score of 12 indicating hazardous drinking.

Risk and Protective Factors

A. Identified risk factors for substance abuse:

Family history of alcohol abuse, social environment

B. Protective factors present:

Stable employment, desire for change

Recommendations and Treatment Planning

Level of care recommended:	[Outpatient counseling]
Referrals to other professionals or services:	[Referral to individual therapy for anxiety]
Initial treatment goals:	[Reduce alcohol use, develop coping skills]

Consent and Confidentiality

Explanation of the purpose of the assessment:	[To inform treatment planning and provide appropriate support]
Consent for treatment and release of information:	[Consent provided for treatment; no release of information at this time]

Counselor's Impressions and Recommendations

Counselor's observations and clinical impressions:	[Client appears motivated for change, insightful about substance use patterns.]
Additional recommendations for intervention or support:	[Explore stress management techniques; consider attending support groups.]

Follow-up Plan

Proposed schedule for follow-up assessments:	[Bi-weekly for the first month, then monthly]
Contingency plans for crisis situations:	[Emergency contact provided; encouraged to seek immediate help if in crisis.]