This quick self-assessment helps evaluate concerns related to physical health, withdrawal symptoms, and mental well-being. By identifying areas of concern, individuals can gain insight into their recovery needs and take the next steps toward healing and support.

Written by clinical psychologist Dr. Hal Baumchen, PsyD, LP, LADC, this printable PDF worksheet gives clinicians a practical, session-ready tool. The conversational, encouraging tone makes clinical concepts accessible to clients at any stage of therapy, while structured prompts keep the work focused and productive.

How clinicians use it: as an in-session exercise to open and structure discussion, as between-session homework to reinforce skills, as a progress tool to track growth over time, and as part of a treatment unit paired with the companion lesson and PowerPoint on this topic. Formatted for easy printing and immediate use in individual or group settings.

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