Directions: Select one of the individuals described in the case studies from Chapter 6 of your textbook: Ann (page 61), Daniel (page 65), Sam (page 67), or Dean (page 72). Based on the information provided in the textbook, complete the following form.

Client Name: Ann
Assessment Date: 06/07/2022

Substance Use History

Drug First Use: Yes or No Pattern of use over time? Frequency of use in past month? Date/amount of most recent use?
Alcohol Yes Occasional weekend evening drinking escalated to daily evening drinks, which transitioned to day drinking on the weekends. Daily Daily alcohol consumption

Sociocultural Factors

  • Educational level: The case study does not specify whether Ann has any higher education.
  • Employment status: Ann is employed, but the case study does not detail her job or whether she works full-time.
  • Current living situation: Ann resides in a small two-bedroom apartment with her husband, two young children, and a parent from another part of the country.
  • Current or past legal problems: The case study does not indicate any current or past legal issues.
  • Describe family history of substance use: There is no reported history of substance abuse in Ann’s extended family.
  • Describe client’s social support system: Ann has the full support of her husband.

Diagnostic Criteria Checklist

Criteria Yes No Criteria Yes No
Was the substance taken in larger amounts or over a longer period of time than intended? Yes   Were important social, occupational, or recreational activities given up or reduced because of substance use? Yes  
Is there a persistent desire or unsuccessful efforts to cut down or control substance use? No   Has the substance been used recurrently in physically hazardous situations? No  
Was a great deal of time spent in activities necessary to obtain or use the substance, or recover from the substance? Yes   Has use continued despite knowing of having a persistent or recurrent physical or psychological problem that is caused or exacerbated by substance use? No  
Have they continued to use the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the substance use? Yes   Has recurrent use of the substance resulted in a failure to fulfill major role obligations at work, school, or home? Yes  
Is tolerance present? Yes   Is withdrawal present? No  
Is there a craving or strong desire or urge to use the substance? No  

 


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