Maryland free online drug and alcohol assessment form for addiction

When faced with court and legal issues in Maryland due to an ongoing drug or alcohol addiction, one of the best options as an alternative to jail time is to enter into a drug rehabilitation center for addiction. For this reason, we have added our free service to aid those in need of help sorting out their legal problems, as well as handling their addiction concerns.

Treatment for addiction in place of jail time in the state of Maryland is a very common outcome for those seeking help to end their addictions. The free online assessment is provided to help those in need of treatment for addiction or as a jail alternative in Maryland. We will help you every step of the way to reach your desired outcome for treatment. Many people choose jail over treatment but we urge you to consider treatment for the best result to handle the addiction. All that is needed to start the process is either fill out the free online assessment form provided below or call us toll-free for a quicker response.

1-800-513-5423

Addiction to drugs or alcohol in Maryland affects more than the person using the drugs or alcohol. All the people in their lives become affected in one way or the other. There can be a lot of damage done due to addiction and all of that can be made up for with time and positive actions. It is our mission to help everyone in need of free addiction services and legal advice due to an ongoing addiction problem. Having someone go to jail over an addiction problem often times, does more harm than good. We have all made decisions that were not the right ones. Complicating a person’s need for help with court issues can be an overwhelming task for those seeking help.

Seeking help for addiction and or court issues in Maryland is the first step to the path to recovering your life and health. Do not wait till something adverse happens to seek help. The time is now to get the help that the person needs so they can start the path to healing and recovering their lives.

Please call our free addiction helpline for immediate assistance.
This is a confidential and free service.

1-800-513-5423

We will help you end the cycle of addiction that has taken a hold of you or another’s life. Do not wait until something adverse happens to commit to treatment for addiction. Give one of our counselors a call today. We have been through addiction and know what it is like to be addicted. Let us help you get into the right treatment center for addiction to drugs or alcohol in Maryland.

Our free online drug and alcohol assessment form for Maryland is provided to you as a free public benefit service. We can help you or someone you love find the best solution to any court issues pertaining to drug and or alcohol addiction. Maryland Free online assessment form is funded by individuals that want to help end addiction in the state of Maryland. We offer programs in many cities including Baltimore, Columbia, Germantown, Silver Spring, Waldorf, Glen Burnie, Ellicott City, Frederick, Dundalk, Rockville Maryland.

Maryland treatment services help those in need of a jail alternative, as well as helps, find treatment for addiction. Please take advantage of our free online assessment form. If you are in need of a quicker response time call us toll-free and we can start the process of getting you addiction treatment help in Maryland. Not all information is required for a response from us which usually takes between 24-48 hours.

Maryland Free Online Drug and Alcohol assessment form for addiction. This is a free public benefit service to help those in need of treatment for addiction find a treatment center that will work for their specific needs. All information provided is strictly confidential and is subject to the privacy act. All information is deleted once we have made contact and help you or a loved one enter into a treatment program.

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.

1-800-513-5423

Free Online Assessment

Please fill out this form if you are in need of placement into an addiction treatment program, detox center, or need help locating inpatient drug or alcohol rehab programs in your area. By filling out this form, you are giving consent to having a counselor contact you, by phone or email, to assist with addiction issues. 100% Confidential. PLEASE NOTE: You can speak immediately with any of our counselors 24 hours a day, 7 days a week by calling 1-800-513-5423

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

---

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:

---

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:

---

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:

---

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:

---

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:

---

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:

---

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:

---

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, and 1 representing information for later use. Please assign a number to this request

12345678910

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

Δ