Divide one sheet into six boxes: current symptoms, timing, alcohol pattern, safety history, previous care, and daily functioning. Under current symptoms, record experiences such as persistent sadness, intense worry, panic, unusual energy, racing thoughts, irritability, confusion, hearing or seeing things others do not, nightmares, or difficulty concentrating. These are observations to disclose, not labels to assign yourself.
For timing, write when each experience began, whether it occurs during drinking, after alcohol use stops, or at unrelated times, and whether it has changed recently. Under alcohol pattern, note what you drink, approximate amounts, frequency, last use, prior attempts to stop, and any concerning experiences after reducing or stopping. Do not use the worksheet to plan a taper. Withdrawal concerns require assessment by qualified professionals. If severe symptoms or immediate danger are present, call 911 instead of waiting for a facility response. Crisis support is available through 988 by call, text, or chat.
- Current symptoms in your own words, including frequency and intensity
- When symptoms started and how they relate to alcohol use or stopping
- Any history of self-harm thoughts, attempts, aggression, or psychiatric crisis care disclosed plainly and promptly to a qualified professional or emergency service as appropriate,