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Drug Court Referral Screening Worksheet

  1. Client Current Contact Information
  2. Custody Status?
  3. Chemical Dependence Screening Tool
  4. The following questions and your answers will only be given to the Drug Court Screener. Under no circumstance will any information be used against you. The information will help your attorney with the referral process into the Yakima County Drug Court.
  5. 1. In the last 12 months, have you ever drank or used drugs more than you meant to?
  6. 2. Have you ever neglected some of your usual responsibilities because of using alcohol or drugs?
  7. 3. Have you felt you wanted to or needed to cut down on your drinking or drug use in the last year?
  8. 4. Has anyone ever objected to your drinking or drug use?
  9. 5. Have you found yourself thinking a lot about drinking or drug use?
  10. 6. Have you ever used alcohol or drugs to relieve emotional discomfort such as sadness, anger, boredom or loneliness?
  11. Scoring = 0-Not appropriate for Drug Court 1 to 6-Refer to Drug Court Screener
  12. Leave This Blank:

  13. This field is not part of the form submission.