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