Severity Rating- Dimension 6 (Recovery/Living Environment) 0 1 2 3 4 None Mild Moderate Severe Very Severe Able to cope in Passive/disinterested social Unsupportive environment, but Unsupportive environment, Environment to recovery. environment/ supportive. support, but still able to cope. able to cope with clinical structure difficulty coping even with clinical Unable to cope and the environment may most of the time. structure. pose a threat to safety. Summary of Multidimensional Screener (Based on rating above) Dimension Severity Rating Rationale Dimension 1 ☐ Substance Use, Acute ☐ ☐ ☐ 0 1 2 3-4 Intoxication, Withdrawal None Mild Moderate Severe Potential Dimension 2 ☐ ☐ ☐ ☐ Biomedical Condition and 0 1 2 3-4 Complications None Mild Moderate Severe Dimension 3 ☐ ☐ ☐ ☐ Emotional, Behavioral, or 0 1 2 3-4 Cognitive Condition and None Mild Moderate Severe Complications Dimension 4 ☐ Readiness to Change ☐ ☐ ☐ 0 1 2 3-4 None Mild Moderate Severe Dimension 5 ☐ Relapse, Continued Use, ☐ ☐ ☐ 0 1 2 3-4 or Continued Problem None Mild Moderate Severe Potential Dimension 6 ☐ Recovery/Living ☐ ☐ ☐ 0 1 2 3-4 Environment None Mild Moderate Severe
Severity Rating- Dimension 6 (Recovery/Living Environment) 0 1 2 3 4 None Mild Moderate Severe Very Severe Able to cope in environment/ supportive. Passive/disinterested social support, but still able to cope. Unsupportive environment, but able to cope with clinical structure most of the time. Unsupportive environment, difficulty coping even with clinical structure. Environment to recovery. Unable to cope and the environment may pose a threat to safety. Summary of Multidimensional Screener Dimension Severity Rating (Based on rating above) Rationale Dimension 1 Substance Use, Acute Intoxication, Withdrawal Potential ☐ 0 ☐ 1 ☐ 2 ☐ 3-4 None Mild Moderate Severe Dimension 2 Biomedical Condition and Complications ☐ 0 ☐ 1 ☐ 2 ☐ 3-4 None Mild Moderate Severe Dimension 3 Emotional, Behavioral, or Cognitive Condition and Complications ☐ 0 ☐ 1 ☐ 2 ☐ 3-4 None Mild Moderate Severe Dimension 4 Readiness to Change ☐ 0 ☐ 1 ☐ 2 ☐ 3-4 None Mild Moderate Severe Dimension 5 Relapse, Continued Use, or Continued Problem Potential ☐ 0 ☐ 1 ☐ 2 ☐ 3-4 None Mild Moderate Severe Dimension 6 Recovery/Living Environment ☐ 0 ☐ 1 ☐ 2 ☐ 3-4 None Mild Moderate Severe
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