- Drinking Alcohol After Work for hours
    - Engaged in a recreational activity while using alcohol (or drugs) for hours.( i.e. ball game, fishing, camping, cook off, party, work function, etc.)
    - Coping with problems (relationship, work, family, etc.)
    - Other


    During the week days, I tend to drink on (place the number of drinks/ amount of drugs used next to a.m./p.m.):

    AM , PM
    AM , PM
    AM , PM
    AM , PM
    AM , PM
    During the week-ends, I tend to drink (or use drugs) on (place the number of drinks/amount of drugs used next to a.m./p.m.):

    AM , PM
    AM , PM
    Summarize any other comments about your drug/alcohol usage and the events leading upto to your arrest below: