Free online drug and alcohol assessments are provided free of charge as a public benefit service to help you or a loved one find treatment for addiction in your area or anywhere in the USA. For immediate service, call now. In some instances, phone contact may be necessary to better assess the situation. In the event of a phone call, the counselor will only identify themselves to the contact person listed below and will advise all others that this is a personal call and will not disclose who we are or why we are calling. All information received from clients is confidential. We are HIPAA compliant.

We can help educate you as to which type of program is best suited for you. We know that entering into a treatment program is a huge step to take and the commitment to treatment can seem overwhelming. Our counselors are here 24/7 to help guide you to the best-suited treatment center for you.  It is sometimes beneficial for the client to go to treatment further away from home. Getting away from temptations and friends who may still be using is often better for many people. Clients who go to rehab in another state also have a harder time leaving treatment early as well. Depending on the situation, our counselors may suggest looking for substance abuse programs that are a plane flight away. Do not wait until something adverse happens before you commit to treatment for addiction. Our certified counselors will help you answer any questions you have.



If you need help locating an inpatient rehabilitation program call to speak with one of our counselors today. We are here to help you find a treatment center that is close to where you live or anywhere in the country.
Please Note: This is not an official assessment or evaluation form. This form is not admissible in court or for probation officers and is not accepted by caseworkers. Addiction No More is here to help you find treatment for addiction. We can not give any legal advice. If you are looking for a rehab center please fill out this form or call us now.

Disclaimer: This evaluation is not intended to constitute a diagnosis of any disorder. The information provided here cannot substitute for a full evaluation by a health professional which must be done in person. Call us 24 hours a day, 7 days a week for help locating a treatment center for addiction.

For immediate assistance, call one of our certified chemical dependency counselors. They are ready to take your call 24 hours a day, 7 days a week. We can help you find addiction treatment today.

1-800-513-5423

Free Online Assessment

Call now for immediate service.

Your Name

Phone Number(Required)

Email Address(Required)

Your Relation to the Individual

Does this individual need treatment for addiction (detox/rehab)?

Individual's General Information

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Individual's Name:

How old is the individual?

Gender

City and State in which they live:

Can they travel outside of this area for treatment?

yes

no

A. Substance Abuse History:

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At what age did the individual start using the substance?:

Please enter a number from 1 to 100.

Current drug(s) being used:

Different drugs used:

Method of use:

Oral

IV (Inject)

Inhale (Smoke)

Nasal (Snort)

Other

Past treatment attempts (What rehab, when, results:)

B). Family History:

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Marital Status

Any children?

yes

no

Who has parenting responsibilities?

History of physical or mental abuse?

yes

no

unsure

Any losses (death) or departures (divorce-separations) from the family institution?

Has the individuals peer structure changed?

yes

no

unsure

C. Social History:

---

Has there been a gradual shift to non-involvement in those activities? (if yes, when)

Has the individual enjoyed any social activities in the past? (if yes, specify)

Does anyone in the individual's immediate (blood) family have/or had a substance abuse problem?

yes

no

unsure

D. Legal History:

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Does the individual have a valid drivers license?

yes

no

unsure

Has the individual ever been arrested? (If so, for what)

Are any crimes actively being committed to support, or as a result of the alcoholism or addiction?

E. Educational History:

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Highest grade completed in grade school

9th10th11th12thsome collegecollege graduate

Vocational Tech?

Yes

No

Any desire or plan of continued or future education?

F. Occupational History:

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Occupation

How Long?

Is this the individuals chosen occupation?

yes

no

unsure

If not chosen profession, what is?

Has the individual ever been terminated as a result of substance abuse?

G. Medical History:

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Does the individual have any medical problems? (Please describe)

Is the individual currently taking any medications?

yes

no

unsure

If yes, please specify what and length of use:

H). Psychological and Behavioral History:

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Has the individual ever been diagnosed and treated for any psychological or emotional problems?

yes

no

unsure

If yes, please specify what and when and outpatient or inpatient

Was the individual prescribed medication for any psychological/emotional problem ?

yes

no

unsure

If yes, please list what drugs where prescribed and length of use:

Additional Information or Comments

On a Scale of 1-10, with 10 representing extreme urgency, please assign a number to this request.

12345678910

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Email

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