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Appendix: Reproducible Client Worksheets
Therapy Techniques Described on the CD
Chemical Use Questionnaire
Client answers the following questions with "yes" or "no"
1. Has a family member or friend expressed concern about your use? 2. Has your social life changed, or have you switched friends? 3. Have you experienced a negative consequence from your use? Legal? Emotional? Physical? 4. Do you find that your behavior changes when you are using chemicals? 5. Are you using chemicals to become more outgoing or to overcome fears? 6. Do you go against your values or morals when you use alcohol or other drugs?
Duties and Responsibilities
1. List on a sheet of paper all of the things you consider to be your responsibility at home, in relationships, and at work. Take your time.
2. Make a detailed list of what responsibilities belong to the other people in your life. If responsibilities are shared, write what percentage of each responsibility belongs to each person.
3. How do your lists compare? Do you find that you have heaped a much larger percentage of responsibility on yourself?
Choices and Consequences
Client answers the following questions
1. Identify times when you have missed school, work, or dates with your friends.
2. How does your behavior change when you use drugs?
3. Identify times when you’ve tried to control your use and ended up using more than you’ve planned.
4. how many times have you had problems caused by chemical use?
5. when have people commented on your use?
I Am Worth It!
I - Decide whether the matter is important.
A - Are your feelings appropriate, given the facts?
M - Is the situation Modifiable?
Worth It! - Is it worth it to take action?