Substance Abuse Family Support Assessment
Family Information
Family Name
Date
Contact Person
Relationship to Individual
Phone Number
Family Structure
List family members and their relationship to the individual:
Substance Abuse Concerns
Describe the substance abuse issue as understood by the family:
Current Supports
What support does the family currently provide?
External supports being accessed (e.g. support groups, counseling):
Impacts on the Family
How has substance abuse impacted family life (emotionally, financially, physically, etc.)?
Family Coping Strategies
What strategies does the family use to cope?
Strengths and Resources
What are the family's strengths and resources?
Needs and Goals
What are the needs and goals for the family regarding support and recovery?
Other Notes
Additional information: