Use one page or phone note with six headings: current experiences, timing, daily impact, safety history, prior care, and substance-use pattern. Under current experiences, record plain descriptions such as “sleeping two hours,” “avoiding people,” “hearing something others do not report hearing,” “racing thoughts,” “panic during withdrawal,” or “unable to complete routine tasks.” Include intensity and frequency in your own words. Do not use the worksheet to label the cause.
Under timing, note when each experience began, whether it appeared before substance use, during use, after stopping, or at unrelated times. Record the most recent occurrence and any clear triggers. Under daily impact, describe effects on eating, sleep, hygiene, work, school, housing, relationships, driving, appointments, and medication use. This gives a reviewer more useful information than saying only that your mental health is “bad.”
- Current experiences, written as observations rather than diagnoses
- Approximate start date, frequency, duration, and recent changes
- Whether experiences occurred before, during, or after substance use or withdrawal risks arose from stopping use or withdrawal concerns should be described to a qualified clinician,