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 Affiliated COUNSELING AND REFERRAL SERVICE

  DR. Michael Shery, clinical psycholoGY

  2615 Three Oaks Rd, Ste. 2A, 

  Cary, Illinois 60013

www.carypsychology.com  847 275 8236 (24 Hrs);  drmike@carypsychology.com

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Doctoral degree: University of Southern California, 1975

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Dr. Michael E. Shery, Clinical Psychologist

2615 Three Oaks Rd, Cary, IL 60013, Ph: 847 275 8236

Illinois License #71-1937

 

Alcohol Use Assessment

 

Subject: Jane Doe

Date of Report: September 14, 2010

The subject is a senior at Anytown High School and was required to undergo an alcohol use evaluation because of her being ticketed for drinking during a post-prom celebration in a rented cabin in Lake Geneva; approximately 20 other teens were also in attendance. Residents of the area called the police because of the noise emanating from the cabin and students were, subsequently, ticketed for underage drinking.

The following are the findings of the assessment.

Structure of Assessment:The assessment consisted of 2 in-office interviews and administration of the Alcohol Use Inventory (AUI).

Dysfunctional History of Alcohol-Related Events:Although using alcohol socially from time-to-time, aside from her being ticketed at this event,the subject and her mother reported no history of her having any other alcohol-influenced situations which caused interpersonal, family or legal problems. She appears to be aware of the risks of badly managed alcohol use and does not appear to generally have maladaptive traits regarding alcohol or other mind-altering substances.

Current Lifestyle

The subject reports a successful academic record, being an A/B student and is involved in extra-curricular activities, including poms. She reports no other troubling or dysfunctional incidents regarding alcohol use; uses no illicit drugs and appears very diligent and goal-oriented.

She also reports having a supportive in-tact family with two siblings.

The Subject's Understanding of Alcohol Use and its Impact: Sheviews herself as goal-oriented, diligent and very embarrassed about being ticketed. Importantly, she appears aware that mismanaged alcohol use can have not only troubling consequences, but also, life-changing ones.

Psychiatric and Medical History:The subject reports no previous history of psychiatric evaluation or treatment and an unremarkable medical history, characterized only by routine conditions, such as colds and flu.

Test Findings: The results suggest that the subject responded to the test items in a forthright manner and did not attempt to present an unrealistic or inaccurate impression.

They indicate that she meets none of the clinical criteria for alcohol dependence or substance abuse and suggests that she has no significant or chronic problems with alcohol or other mind-altering substances.

The problems leading to the ticketing are more likely the result of poor judgment in participating in a social activity where alcohol was being consumed in a dysfunctional way. They appear unrelated to any alcohol-oriented lifestyle.

In sum, the subject appears acutely aware of the risks associated with using alcohol inappropriately in social situations and while driving and is not likely to repeat her mistake, particularly after undergoing all the consequences this ticketing has entailed.

 

Respectfully Submitted,_________________________;________

Dr. Michael Shery, Psychologist Date

 

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