Alcohol Cessation Log Form
Track your daily progress and experiences as you work toward alcohol cessation.
Date of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Full Name
*
First Name
Last Name
Time of Log
*
Hour Minutes
AM
PM
AM/PM Option
Number of Drinks Consumed Today
*
Did you experience any cravings or triggers today?
*
Yes
No
Describe any cravings or triggers you experienced
Mood/Feelings Today
*
Please Select
Very Positive
Positive
Neutral
Negative
Very Negative
Strategies Used to Avoid Alcohol
*
Avoided triggers
Called a support contact
Attended a support group
Practiced relaxation techniques
Distracted myself with a hobby
Other
Support Contacts or Resources Used
Additional Notes or Comments
Overall Progress Rating Today
*
1
2
3
4
5
Submit Log
Should be Empty: