SUBSTANCE USE AGE AT AGE OF ROUTE AVERAGE DAYS DAYS DAYS LAST HISTORY FIRST REGULAR OF USE DAILY USE USED IN USED IN INJECTED IN USE USE USE PAST PAST FOUR PAST FOUR (Detail name of specific (Oral, inject, (Quantity per day in substances used) etc) past four weeks, cost, WEEK WEEKS no. of injections, binge use etc) Tobacco products Alcoholic beverages Cannabis (marijuana, pot, hash, synthetic cannabis etc) Amphetamine type stimulants (speed, meth, ice, diet pills,ecstasy etc) Inhalants (nitrous, glue, petrol, paint thinner etc) Sedatives or Sleeping pills (benzodiazepines, serapax, rohypnol etc) Prescribed: yes no Hallucinogens (LSD, acid, mushrooms, PCP, Special K etc) Opioids (heroin, codeine, methadone, oxycodone, morphine etc) Prescribed: yes no Other (cocaine, GHB etc) 1B) CURRENT DRUG USE (signs of intoxication, withdrawal, BAC)
SUBSTANCE USE HISTORY (Detail name of specific substances used) AGE AT FIRST USE AGE OF REGULAR USE ROUTE OF USE (Oral, inject, etc) AVERAGE DAILY USE (Quantity per day in past four weeks, cost, no. of injections, binge use etc) DAYS USED IN PAST WEEK DAYS USED IN PAST FOUR WEEKS DAYS INJECTED IN PAST FOUR LAST USE Tobacco products Alcoholic beverages Cannabis (marijuana, pot, hash, synthetic cannabis etc) Amphetamine type stimulants (speed, meth, ice, diet pills,ecstasy etc) Inhalants (nitrous, glue, petrol, paint thinner etc) Sedatives or Sleeping pills (benzodiazepines, serapax, rohypnol etc) Prescribed: yes no Hallucinogens (LSD, acid, mushrooms, PCP, Special K etc) Opioids (heroin, codeine, methadone, oxycodone, morphine etc) Prescribed: yes no Other (cocaine, GHB etc) 1B) CURRENT DRUG USE (signs of intoxication, withdrawal, BAC)
_step_2_-_comprehensive_assessment_for_adults_with_aod_problems.docx