These resources are ideal for addiction recovery centers, counselors, or organizations managing substance abuse programs.
Purpose: Ensure a thorough assessment of individuals enrolling in a drug and alcohol addiction program.
| Task | Completed (?/?) | Notes/Details |
|---------------------------------------------|---------------------|----------------------------------------|
| Collect client’s personal information | | Name, age, gender, contact details. |
| Complete medical history questionnaire | | Include any chronic illnesses or injuries. |
| Record history of substance use | | Type, frequency, duration of use. |
| Assess mental health history | | Previous diagnoses (e.g., depression, anxiety). |
| Administer substance use screening tools | | Tools like AUDIT (Alcohol Use Disorders Identification Test) or DAST (Drug Abuse Screening Test). |
| Obtain consent forms for treatment | | Include HIPAA compliance if applicable. |
| Screen for withdrawal risks | | Refer to medical detox if necessary. |
| Assign a case manager or counselor | | Name and contact information. |
Purpose: Develop a personalized plan to address the client’s specific needs and recovery goals.
| Client Name: [Insert Name] | Date: [Insert Date] |
| Section | Details |
|--------------------------------------------|--------------------------------------------|
| Short-Term Goals | E.g., "Complete detox within 7 days." |
| Long-Term Goals | E.g., "Maintain sobriety for 12 months." |
| Support Services | E.g., individual counseling, group therapy. |
| Skills Development | E.g., coping strategies, stress management. |
| Medication-Assisted Treatment (if applicable) | E.g., methadone or buprenorphine. |
| Schedule | Weekly therapy sessions, support groups. |
| Metrics for Success | Reduced substance use, improved physical health. |
| Assigned Counselor/Support Team | Name(s) and contact info. |
Purpose: Track the client’s daily progress and engagement in the program.
| Task/Activity | Completed (?/?) | Notes/Details |
|---------------------------------------------|---------------------|----------------------------------------|
| Attend group therapy session | | Note participation and engagement. |
| Complete individual counseling session | | Summarize key takeaways or concerns. |
| Participate in skill-building activities | | E.g., mindfulness, stress relief techniques. |
| Take prescribed medication | | Ensure compliance with dosage. |
| Complete journaling or reflection exercises | | Note any significant insights. |
| Avoid triggers (e.g., specific environments) | | Record if any challenges arose. |
| Engage in physical activity or wellness routine | | E.g., yoga, exercise, or meditation. |
Purpose: Help clients identify triggers and develop strategies to avoid relapse.
| Client Name: [Insert Name] | Date: [Insert Date] |
| Section | Details |
|--------------------------------------------|--------------------------------------------|
| Triggers | Identify personal triggers (e.g., stress, social settings). |
| Coping Strategies | E.g., deep breathing, calling a sponsor. |
| Support Network | List contacts (family, sponsor, therapist). |
| Safe Places | Locations where the client feels secure (e.g., home, recovery center). |
| Emergency Plan | Steps to take during cravings or a relapse (e.g., call hotline, attend a meeting). |
| Positive Activities | Hobbies or actions to distract from substance use. |
| Warning Signs of Relapse | E.g., mood changes, avoiding support groups. |
Purpose: Monitor weekly progress and adjust treatment plans as necessary.
| Week Ending: [Insert Date] | Client Name: [Insert Name] |
| Category | Progress | Notes/Comments |
|--------------------------------------------|--------------------------------------------|----------------------------------------|
| Attendance | [E.g., Attended all sessions or missed 1 group meeting.] | |
| Engagement | [E.g., Actively participated in discussions.] | |
| Substance Use Reduction | [E.g., No substance use reported.] | |
| Coping Strategies | [E.g., Practiced deep breathing during stress.] | |
| Mental Health Improvement | [E.g., Anxiety levels decreased, improved mood.] | |
| Physical Health | [E.g., Gained weight, improved energy levels.] | |
| Challenges | [E.g., Experienced cravings on Friday evening.] | |
Purpose: Engage and involve the client’s family in the recovery process.
| Task | Completed (?/?) | Notes |
|---------------------------------------------|---------------------|-------------------------------------|
| Schedule family counseling sessions | | Ensure family members are supportive. |
| Provide education on addiction | | Share information about addiction as a disease. |
| Share the relapse prevention plan | | Ensure family understands their role in supporting the client. |
| Discuss boundaries and expectations | | Clarify how the family can set healthy limits. |
| Address co-dependency issues | | Work through any enabling behaviors. |
| Create a family communication plan | | Establish open and honest dialogue. |
Purpose: Ensure clients have a structured plan for continued success post-treatment.
| Client Name: [Insert Name] | Date of Discharge: [Insert Date] |
| Section | Details |
|--------------------------------------------|--------------------------------------------|
| Aftercare Services | E.g., weekly counseling, 12-step meetings. |
| Support Contacts | Sponsor, therapist, support group leader. |
| Emergency Hotline Numbers | [Insert local/national hotline details.] |
| Ongoing Medication | Prescriptions and dosages, if applicable. |
| Follow-Up Appointments | Dates and times for future check-ins. |
| Employment/Education Plan | Vocational training or job placement. |
| Personal Goals | E.g., remain sober for 90 days, rebuild relationships. |
Purpose: Assess the effectiveness of the addiction program.
| Evaluation Area | Question | Response/Rating |
|--------------------------------------------|--------------------------------------------|-------------------------------------|
| Program Completion Rate | What percentage of clients complete the program? | [Insert Value] |
| Client Satisfaction | How satisfied are clients with their treatment? | [E.g., 1-5 Stars or survey feedback] |
| Relapse Rate | What percentage of clients relapse within 6 months? | [Insert Value] |
| Staff Performance | Are counselors meeting expectations for engagement and support? | [Yes/No/Needs Improvement] |
| Aftercare Success | How many clients continue aftercare services? | [Insert Value] |
| Facility Condition | Is the environment safe and welcoming? | [Yes/No/Needs Improvement] |
Purpose: Organize group therapy sessions effectively.
| Session Date: [Insert Date] | Facilitator: [Insert Name] |
| Section | Details |
|--------------------------------------------|--------------------------------------------|
| Topic | [E.g., Coping with Triggers] |
| Objectives | [E.g., Teach practical coping mechanisms.] |
| Activities | [E.g., Group discussion, role-playing.] |
| Materials Needed | [E.g., Whiteboard, handouts.] |
| Duration | [E.g., 60 minutes] |
| Follow-Up | [E.g., Ask participants to journal about their triggers.] |
Purpose: Document and analyze relapse incidents for improvement.
| Date of Incident: [Insert Date] | Client Name: [Insert Name] |
| Category | Details |
|--------------------------------------------|--------------------------------------------|
| Substance Used | [E.g., Alcohol, opioids] |
| Trigger | [E.g., Stress, peer pressure, social event] |
| Support Contacted | [Sponsor, counselor, hotline] |
| Immediate Actions Taken | [E.g., Attended meeting, sought medical help.] |
| Plan to Address Future Risk | [E.g., Adjust relapse prevention plan.] |