Substance Use Monitoring Log Form
Log and track substance use events for monitoring and self-reflection. This form helps you record relevant details for each entry in a clear and approachable way.
Date and Time of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Substance Used
*
Please Select
Alcohol
Cannabis
Nicotine
Prescription Medication (non-prescribed use)
Over-the-Counter Medication
Other Substance
Amount or Dosage Used
*
Method of Use
*
Please Select
Oral
Inhalation
Injection
Topical
Other
Context or Situation (Where/With Whom)
Mood Before Use
*
Please Select
Happy
Sad
Anxious
Angry
Bored
Stressed
Other
Mood After Use
*
Please Select
Happy
Sad
Anxious
Angry
Bored
Stressed
Other
Triggers or Cravings Experienced
Stress
Social Pressure
Boredom
Habit
Other
Support or Coping Strategies Used
Contacted a friend or support person
Attended a group or meeting
Used relaxation or mindfulness
Distracted self with activity
Other
Additional Notes or Reflections
Submit Log Entry
Should be Empty: