SOP_NUMBER: 508.44-att-1 TITLE: Addiction Severity Index Summary Assessment DIVISION: Unknown TOPIC_AREA: 508 Policy-MH Evaluations/Screenings/Treatment EFFECTIVE_DATE: 2023-10-19 WORD_COUNT: 212 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/738975 URL: https://gps.press/sop-data/508.44-att-1/ SUMMARY: This is a standardized assessment form used to document an inmate's addiction severity and related health and social factors. The form captures information about the inmate's medical history, employment, alcohol and drug use, legal status, family history, psychiatric status, and identifies significant problems across multiple domains. The completed assessment is retained in the inmate's mental health record for 10 years or until the end of mental health services. KEY_TOPICS: addiction severity index, ASI assessment, substance abuse screening, drug and alcohol evaluation, mental health evaluation, inmate assessment form, psychiatric screening, addiction assessment, co-occurring disorders, substance use history ATTACHMENTS: 1. Addiction Severity Index Summary Assessment URL: https://gps.press/sop-data/508.44-att-1/ 2. Integrated Treatment Programs 4 Quadrant Assignment (Attachment 2) URL: https://gps.press/sop-data/508.44-att-2/ 3. Summary of Monthly Progress in the ITF (Attachment 3) URL: https://gps.press/sop-data/508.44-att-3/ ======================================================================== FULL TEXT: ======================================================================== 508.44 Attachment 1 10/19/2023 **Georgia Department of Corrections** **Addiction Severity Index Summary Assessment** Facility:____________________________ Date of Assessment:__________________ Name:_____________________________ GDC#:_____________________________ DOB:_____________________________ Race:______________________________ **General Information:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ **Medical History:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ **Employment Support:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ **Alcohol and Drug Usage:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Retention: Attachment 1, shall be placed in the offender’s mental health record, section four (4). At the end of the offender’s need for mental health services and/or sentence, the mental health record will be placed within the offender’s health record and retained for 10 years. 508.44 Attachment 1 10/19/2023 **Legal Status:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ **Family History:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ **Family and Social Relations:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ **Psychiatric Status:** _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Retention: Attachment 1, shall be placed in the offender’s mental health record, section four (4). At the end of the offender’s need for mental health services and/or sentence, the mental health record will be placed within the offender’s health record and retained for 10 years. 508.44 Attachment 1 10/19/2023 **Significant Problems (based on previous 2 pages)** Mental health/psychiatric: _______________________________________________________________ _____________________________________________________________________________________ Alcohol/drug usage: ____________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Medical: _____________________________________________________________________________ ____________________________________________________________________________________ Employment support: __________________________________________________________________ ____________________________________________________________________________________ Family/Social support: _________________________________________________________________ ____________________________________________________________________________________ Housing/Residence planning: ____________________________________________________________ _____________________________________________________________________________________ Legal: _______________________________________________________________________________ _____________________________________________________________________________________ Other: ______________________________________________________________________________ ____________________________________________________________________________________ Staff Name: ____________________________ Title: ________________________________ Staff Signature: ________________________________ **___________________________________________________________________________________** Reviewed by: ____________________________ _____________________________________ (Name) (Title) Signature: ______________________________ Date: _________________________________ Retention: Attachment 1, shall be placed in the offender’s mental health record, section four (4). At the end of the offender’s need for mental health services and/or sentence, the mental health record will be placed within the offender’s health record and retained for 10 years.