---
title: Substance Abuse Screening Form Template with CAGE Assessment | Paperform
description: Confidential substance abuse screening tool with CAGE questionnaire, drug use history, mental health assessment, and treatment resources. HIPAA-ready and customizable for healthcare providers.
url: "https://paperform.co/templates/substance-abuse-screening-assessment-form"
type: static
generatedAt: "2026-03-28T00:45:17.945Z"
---

[← Back to free form templates](/templates/)    ![Substance Abuse Screening & Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/substance-abuse-screening-assessment-form.png)
    [Preview](https://_preview.paperform.co/ai-template/substance-abuse-screening-assessment-form) [Use this template for free](/create?ai-template=substance-abuse-screening-assessment-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Mental Health](/templates/industry/mental-health/)[Human Resources](/templates/industry/human-resources/)[Nonprofit](/templates/industry/nonprofit/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Therapist](/templates/role/therapist/)[Counselor](/templates/role/counselor/)[Psychologist](/templates/role/psychologist/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Comprehensive Substance Abuse Screening Made Simple

Substance abuse screening is a critical first step in identifying individuals who may benefit from intervention, treatment, or support services. Whether you're a healthcare provider, counselor, community health organization, or employee assistance program, having a structured, confidential screening tool is essential for early detection and timely referral.

This **Substance Abuse Screening & Assessment Form** template provides a complete, evidence-based approach to evaluating substance use patterns, incorporating the widely-recognized CAGE questionnaire alongside comprehensive drug use history, mental health comorbidity screening, and immediate connections to treatment resources.

#### Why Use Paperform for Substance Abuse Screening?

Paperform transforms traditional substance abuse screening from paper-based questionnaires into a secure, professional digital experience that respects client privacy while streamlining your workflow.

**Confidential & Secure**: With SOC 2 Type II compliance and GDPR adherence, Paperform ensures that sensitive health information is protected. Set up anonymous submissions or use conditional logic to maintain confidentiality while still capturing essential data.

**Evidence-Based Assessment**: This template includes the validated CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener) for alcohol screening, plus structured questions about drug use frequency, types of substances, and administration methods—giving clinicians a comprehensive baseline for risk assessment.

**Mental Health Integration**: Substance abuse rarely exists in isolation. This form screens for common mental health comorbidities including depression, anxiety, PTSD, and trauma history, helping identify dual-diagnosis cases that require integrated treatment approaches.

**Immediate Resource Connection**: Rather than ending with just data collection, the form includes treatment readiness assessment and provides pathways to connect individuals with appropriate resources, crisis support, and next steps.

#### Who Benefits from This Template?

**Healthcare Providers & Clinics**: Primary care physicians, nurses, and medical assistants can use this screening tool during routine visits or as part of comprehensive health assessments, identifying at-risk patients before substance use escalates.

**Mental Health Professionals**: Therapists, counselors, and psychologists can incorporate this form into intake processes to understand the full scope of a client's challenges and tailor treatment accordingly.

**Employee Assistance Programs**: HR professionals and EAP coordinators can offer confidential screening to employees, connecting them with support services early and reducing workplace impacts of substance abuse.

**Community Health Organizations**: Nonprofit health centers, harm reduction programs, and public health agencies can deploy this tool for outreach, research, and connecting vulnerable populations with treatment resources.

**Addiction Treatment Centers**: Intake coordinators can use this form as a pre-admission assessment, gathering essential information before an initial consultation and triaging cases based on severity.

#### Key Features of This Template

**CAGE Questionnaire Integration**: The gold-standard four-question CAGE assessment provides a quick, reliable alcohol screening that has been validated across diverse populations and clinical settings.

**Comprehensive Substance History**: Beyond alcohol, the form assesses use of cannabis, opioids, stimulants, benzodiazepines, hallucinogens, and other substances, capturing frequency, duration, and patterns of use.

**Risk Stratification**: Conditional logic can be added to calculate risk scores and automatically route high-risk cases for immediate follow-up, ensuring no one falls through the cracks.

**Mental Health Comorbidity Screening**: Questions about depression symptoms, anxiety, trauma history, and previous mental health treatment help identify dual-diagnosis cases requiring integrated care.

**Treatment Readiness & Motivation**: The form assesses where individuals are in their change journey—from pre-contemplation to action—helping providers match interventions to readiness levels.

**Streamline with Stepper Automation**: Connect your screening form to [Stepper](https://stepper.io) to automate follow-up workflows. When a high-risk screening is submitted, automatically send emails to case managers, create tasks in your practice management system, schedule follow-up calls, or trigger crisis intervention protocols—all without manual data entry.

**Professional, Compassionate Design**: The form uses clear, non-judgmental language and a calming visual design to reduce stigma and encourage honest responses, crucial for effective screening.

#### Enhancing Your Screening Process

**Integrate with EHR Systems**: Use Paperform's integration capabilities to push screening results directly into your electronic health record system, ensuring continuity of care and easy access for treatment teams.

**Automate Resource Distribution**: Based on responses, automatically send customized follow-up emails with relevant treatment resources, support group information, crisis hotline numbers, and next steps.

**Track Outcomes Over Time**: For ongoing treatment monitoring, use Paperform to administer follow-up screenings at regular intervals, tracking progress and adjusting treatment plans as substance use patterns change.

**Multi-Language Support**: Paperform supports multiple languages, making it easy to offer screening in the languages your community speaks, improving accessibility and response quality.

#### The Paperform Advantage for Healthcare Screening

Unlike rigid survey tools or complex medical software, Paperform gives healthcare professionals a flexible platform that's both powerful and easy to use. The document-style editor means clinical staff can customize questions, add educational content, and adjust screening protocols without waiting for IT support.

With built-in conditional logic, you can create branching paths that adapt to responses—asking detailed follow-up questions only when relevant, keeping the form concise for low-risk individuals while gathering comprehensive data for those who need it.

For organizations screening large populations, Paperform's reporting and analytics help identify trends, measure program effectiveness, and demonstrate impact to funders and stakeholders. Export data to SPSS, Excel, or your preferred analytics tool, or use AI Insights to quickly summarize patterns across hundreds of screenings.

#### Getting Started

This template is ready to use out of the box, but you can easily customize it to match your organization's specific protocols, add your branding, or include local treatment resources and referral pathways. Whether you're conducting one-on-one screenings, deploying community-wide assessments, or building a comprehensive intake process, this form provides the foundation for compassionate, effective substance abuse screening.

Paperform is trusted by healthcare organizations worldwide for secure, compliant data collection. Start with this template today and make substance abuse screening more accessible, efficient, and connected to the help people need.
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