Free screening tool for the signs and symptoms of substance use disorders. Part of the Treatment Improvement Protocol (TIP) Series.

This substance abuse screening instrument was designed to encompass a broad spectrum of signs and symptoms for substance use disorders. These conditions are characterized by substance use that leads to negative physical, social, and/or emotional consequences and loss of control over one's pattern and amount of consumption of the substance(s) of abuse.

SAMHSA created this form, which can be reproduced for free. For more information about this and other assessment tools see the Treatment Improvement Protocol (TIP) Series 42.

Click for ScreenshotFeatures:

• Fill in, Print and Save with Adobe Reader
• Data Fields highlighted in blue for easy recognition
• Built-in hyperlinks to SAMSHA - TIP 42 manual.

Fill & Save as a PDF compliments of Fiachra Forms

Fiachra Forms has created this PDF form with the "local save" capability enabled. Once the form is completed, simply choose “save as” to name the assessment. Requires the current version of Adobe Reader.


Click for screenshot


Public Domain Notice

All materials appearing in this form are in the public domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Do not reproduce or distribute this publication for a fee without specific, written authorization from SAMHSA's Office of communications.