Substance Use Self-Monitor Log
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Text in this Example:
Client's Name
Week
Substance Use Self-Monitor Log
Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Substance Abuse Relapse Prevention for Older Adults: A Group Treatment Approach 2005
Day of the week
What time is it?
Where are you?
Whom are
you with?
What has just
happened?
How are you
feeling?
If you drank or used a substance
What
and how
much?
How do
you feel?
happened
afterward?
If you did not drink or use drugs what are you doing instead?
Check days you did not drink or use drugs
Mon
Tue
Wed
Thu
Fri
Sat
Sun
