CHAT Tool - Offender Health Research Network
CHAT Tool - Offender Health Research Network
CHAT Tool - Offender Health Research Network
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Drug/Alcohol History and Misuse (Continued)<br />
SUBSTANCE<br />
AGE<br />
FIRST<br />
USED<br />
CURRENT USE<br />
(within last<br />
1/12)<br />
State amount<br />
and frequency<br />
used e.g. once<br />
per month;<br />
once per<br />
week; once<br />
per day<br />
PAST USE<br />
(over<br />
1/12)<br />
State<br />
amount<br />
and<br />
frequency<br />
of each<br />
substance<br />
used<br />
CURRENT<br />
SPENDING<br />
For<br />
substances<br />
currently<br />
used, identify<br />
how much<br />
young person<br />
spends per<br />
week<br />
ROUTE e.g.<br />
- Inject<br />
-Smoke<br />
(pipe, foil,<br />
roll)<br />
- Nasal<br />
(inhale)<br />
- Oral (bong)<br />
- Snort<br />
- Swallow<br />
EVER<br />
OVERDOSED<br />
- Never<br />
- In past (over<br />
1/12)<br />
-Recently<br />
(within 1/12)<br />
EVER<br />
INCREASED<br />
USE FOR<br />
SAME<br />
EFFECT<br />
- Never<br />
- In past<br />
-Recently<br />
TRIED<br />
BUT<br />
UNABLE<br />
TO STOP<br />
- Never<br />
- In past<br />
-Recently<br />
EXPERIENCED<br />
WITHDRAWAL<br />
IF USED LESS<br />
- Never<br />
- In past<br />
-Recently<br />
HALLUCINOGENS e.g.<br />
LSD, Ketamine<br />
MEPHEDRONE (‘Meow’,<br />
MCAT)<br />
INHALANTS/VOLATILE<br />
SUBSTANCES e.g. gas<br />
solvents, aerosols, glue<br />
Surname:<br />
DOB:<br />
Forenames:<br />
NHS Number:<br />
<strong>CHAT</strong> <strong>Tool</strong> Secure Estate (Version 3 - June 2013)<br />
50 | P age
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