Liz Davis, M.A., LPC

• Significant current suicidal or homicidal ideation without intent or conscious plan and without past history.
• No active suicidal/homicidal ideation, but extreme distress and/or a history of suicidal/homicidal behavior exists.
• History of chronic impulsive suicidal/homicidal behavior or threats, but current expressions do not represent significant change from usual behavior.
• Binge or excessive use of substances resulted in potentially harmful behaviors in the past, but there have been no recent episodes.
• Some evidence of self-neglect and/or decrease in ability to care for oneself in current environment.

• Recently conflicted, withdrawn, alienated or otherwise troubled in most significant relations, but maintains control of any impulsive, aggressive or abusive behaviors.
• Appearance and hygiene falls below usual standards on a frequent basis.
• Significant disturbances in physical functioning such as sleep, eating habits, activity level, or sexual appetite, but without a serious threat to health.
• Significant deterioration in ability to fulfill responsibilities and obligations to job, school, self, or significant others and these may be avoided or neglected on some occasions.
• Ongoing and/or variably sever deficits in interpersonal relationships, ability to engage in socially constructive activities, and ability to maintain responsibilities.
• Recent gains and/or stabilization in function have been achieved wile participating in treatment in a structures and/or protected setting.

• Medical conditions exist, or have potential to develop (such as diabetes or a mild physiological withdrawal syndrome), which may require significant medical monitoring.
• Medical conditions exist which may be created or adversely affected by the existence of the presenting disorder.
• Medical conditions exist which may adversely affect the course of the presenting disorder.
• Ongoing or episodic substance use occurring despite negative consequences with significant or potentitally significant negative impact on the course of any co-existing psychiatric disorder.
• Recent substance use which has had clearly detrimental effects on the presenting disorer but which has been temporarily arrested through use of a highly structured or protected setting or through other external means.
• Significant psychiatric symptoms and signs are present which are themselves somewhat debilitating, and which interact with and have an adverse affect on the course and severity of any co-existing substance use disorder.

• Significant discord or difficulties in family or other important relationships or alienation from social interaction.
• Significant transition causing disruption in life circumstances such as job loss, legal difficulties or change of residence.
• Recent important loss or deterioration of interpersonal or material circumstances.
• Concern related to sustained decline in health status.
• Danger in or near habitat.
• Easy exposure and access to alcohol and drug use.
• Perception that pressure to perform surpasses ability to meet obligations in a timely or adequate manner.

Recovery Environment
b. Level of Support, 3 or below – MODERATE

• A few supportive resources exist in current environment and may be capable of providing some help if needed.
• Usual sources of support may be somewhat ambivalent, alienated, difficult to access, or have a limited amount of resources they are willing or able to offer when needed.
• Persons who have potential to provide support have incomplete ability to participate in treatment and make necessary changes.
• Resources may be only partially utilized even when available.
• Limited constructive involvement with any professional sources of support that are available.

• Previous or current treatment has not achieved complete remission of symptoms or optimal control of symptoms.
• Previous treatment exposures have been marked by minimal effort or motivation and no significant success or recovery period was achieved.
• Unclear response to treatment and ability to maintain a significant recovery.
• At least partial recovery has been maintained for moderate periods of time, but only with strong professional or peer support or in structured settings.

• Has some variablity, hesitation or uncertainty in acceptance or understanding of illness and disability.
• Has limited desire or lacks confidence to change despite intentions to do so (Preparation Stage, Prochaska & DiClemente).
• Relates to treatment with some difficulty and establishes few, if any, trusting relationships.
• Does not use available resources independently or only in cases of extreme need.
• Has limited ability to accept responsibility for recovery.