Resource Guide: Screening for Drug Use in General Medical Settings

See http://www.hhs.gov/opa/familylife/tech_assistance/resources/ami-materials.pdf (PDF, 2 MB) for more information and examples.

The changes I want to make (or continue making) are:

The reasons why I want to make these changes are:

The steps I plan to take in changing are:

The ways other people can help me are:

I will know that my plan is working if:

Some things that could interfere with my plans are:

What will I do if the plan isn't working:

As my doctor, you can help me keep these changes by: