DAILY DRUG MONITORING LOG
Name: ______________________ Year: 20______
Primary Drug: _______________ Second Drug: ____________
Used Drugs Today? Total # Any Urges When you had urges,
Y = Yes Record Situations
Date Alcohol to Use or used drugs, record
N = No Related to
Drinks Drugs any thoughts or
Month Drug Use or Urges
If no Today? feelings you
and
Day drinking, Y = Yes (e.g., alone, with experienced
write “0 N = No others, social situation, (e.g., stress, anger,
Primary Second
sporting events happiness).
Mon
Tue
Wed
Thu
Fri
Sat
Sun
USE THE BACK OF THIS PAGE FOR ADDITIONAL NOTES RELATED TO YOUR DRINKING (e.g., reasons for use)
ADDITIONAL NOTES
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