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621 East Carnegie Drive, Suite 210, San Bernardino, CA 924150503 Phone: 8009682636 Fax: 9093812172 www.SBCounty.govDepartment of Behavioral Health Substance Use Disorder and Recovery Services San
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To fill out substance use disorder:
02
Gather all relevant information - gather any medical records, previous treatment history, and any information related to substance use.
03
Start with personal information - provide your full name, date of birth, address, phone number, and social security number.
04
Describe the substance use - provide details about the substances you have been using, including the frequency, amount, and duration of use.
05
Provide medical history - include any past or current medical conditions that may be relevant to your substance use disorder.
06
Describe previous treatment - provide information about any previous treatments or therapies you have undergone for substance use disorder.
07
Explain the impact on your life - describe how substance use has affected your daily life, relationships, work, and other aspects.
08
Include any additional information - if there are any additional details or circumstances you think are important, make sure to include them in the form.
09
Review and sign - carefully review the completed form and sign it to acknowledge the accuracy of the information provided.

Who needs substance use disorder and?

01
Substance use disorder is relevant to individuals who are struggling with addiction or dependency on substances such as alcohol, drugs, or prescription medications.
02
It is also applicable to individuals who have experienced negative consequences as a result of their substance use, such as health issues, financial problems, legal troubles, or strained relationships.
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Anyone who recognizes the need for help and support in overcoming their substance use and wants to seek treatment or rehabilitation can benefit from addressing substance use disorder.
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Substance use disorder (SUD) is a medical condition characterized by an individual's inability to control their use of a substance, leading to significant impairment or distress. It often involves a range of problematic behaviors, including addiction to drugs or alcohol.
Individuals who have been diagnosed with a substance use disorder may be required to file for various healthcare or administrative purposes, such as those seeking treatment, benefits, or legal action related to their condition.
Filling out documentation related to substance use disorder typically involves providing personal information, a detailed history of substance use, treatment details, and any relevant medical or psychological evaluations that support the diagnosis.
The purpose of identifying and documenting substance use disorder is to facilitate appropriate treatment, enable access to support services, track the effectiveness of interventions, and inform both healthcare providers and patients about the severity of the condition.
Key information that must be reported includes personal identification details, history of substance use, any co-occurring mental health disorders, prior treatment attempts, and current treatment plans.
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