Alcohol and Smoking Assessments



Alcohol, Drug and Smoking Assignment

HE 250 Personal Health (20 Points Possible)

Student Name:     

Assignment Goals:

1) Assess your current alcohol, drug and smoking use

2) Reflect upon how substance use affects either you or those around you

3) Identify future health implications of your (or those around you) substance use

4) Assess each of the health dimensions as related to substance use

Directions:

For this assignment, you will need to complete the assessments listed below and record your scores and comments in the appropriate locations (grey-shaded boxes) on this paper. Use italics or a blue or magenta font for your responses to assist me with reading the assignment.

1. Alcohol Assessment

2. Part II Smoking section

If you do not use drugs or drink alcohol, have someone that you know who does fill out the assessment AND interview that person for the information you will need to answer the questions to complete Part I.

Part I: Alcohol Assessment (5 points)

Complete Worksheet 51: “Is Alcohol a Problem in your Life” (PDF File) and record your scores below.

Your CAGE Screening Test result:      

Your AUDIT Screening Test Total points:      

From your results in the Part 1 assessments, what information was most meaningful to you and why?     

Part II: Smoking Assessment (5 points).

Complete below Section A if you have never smoked.  Complete section B if you currently smoke or have smoked in the past

Section A: If you never smoked

List five things you might say to someone in asking him or her not to smoke in your presence. How would

you defend your right to breathe smoke-free air?      

List three situations where you recall being exposed to cigarette smoking. For each, describe what you might

have done to avoid the situation.      

Why do you think you never started smoking?      

Section B: If you smoke – or ever have smoked, please fill out the Wellness Worksheet #56 For Smokers Only: Why do you Smoke” at the publisher website:



Once at the website click on Wellness Worksheets, click on link provided, scroll down to #56 and click on the link. Your worksheet will come up. Record your totals below:

|Reason to Smoke |Score |High or Low? |

|Stimulation | | |

|Handling | | |

|Pleasurable Feelings | | |

|Crutch: Tension Reduction | | |

|Craving: Psychological Addiction | | |

|Habit | | |

Most people smoke for one or more broad, primary reasons: Stimulation, Handling, Pleasurable Feelings, Crutch, Craving, or Habit. Which two reasons had the highest score in your (their) smoking assessment?     

Develop strategies for each of the two identified primary reasons for smoking.     

If you have quit smoking, why did you quit?      

Part III – Reflective Paper (10 points)

Reflect upon how alcohol, drugs (legal, illegal, and prescription) or smoking has affected you or a friend/family members’ life. In your reflection process, think about the health dimensions- physical, social, emotional, intellectual, and spiritual. Share your reflections below in the appropriate area. Use italics or a blue or magenta font for your responses to assist me with reading the assignment. Your total response should be the equivalent of a one-page, single spaced paper.

Physical dimension      

Social dimension      

Emotional dimension      

Intellectual dimension      

Spiritual dimension      

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