The examples listed below are just some of the changes you may see in a problem drinker and should only be used as a general guideline.
Attendance
Late for class
Starts to cut classes
General Behavior
Overreacts to situations
Complains of not feeling well
Lies
School Performance
Misses deadlines
Makes mistakes through inattention or poor judgment
Inconsistency in quality of work
Attendance
Leaves early for weekend or semester break
Regularly cuts classes
General Behavior
Statements become undependable
Begins to avoid situations where there is no alcohol or other drugs
Asks for money more regularly/overdrawn checking account
Student Health/ER visits for illness and/or minor accidents
School performance
General deterioration
Attendance
Cuts classes a week at a time
General Behavior
Other students concerned
Brought to the attention of the bad check committee
Grandiose, aggressive, belligerent or passive, withdrawn
Personal problems interfere with school
Apparent loss of ethical values
Works, in spite of adequate parental support, to finance the drinking
Major illness or accident
Refuses to discuss problems
Judiciary or honor committee problems
Legal problems
School Performance
Far below expected level - academic probation
Attendance
Takes semester off or drops out
General Behavior
Drinking or using other drugs before class
Totally undependable
Repeated illnesses or physical problems
Visible deterioration
Financial difficulties; may resort to criminal activities to pay for
alcohol/other drugs
Serious family or relationship problems
Repeated legal problems (including DUI arrests)
School Performance
Academic suspension
Behavior Checklist
Please check areas of concern
__ Low Grades __ Wetting, soiling cloths __ Academic Failure __ Unstable home environment (frequent __ Always Behind in Class concern about supervision) __ Lack of Motivation-Apathy __ No friends__ Deteriorating Classroom Performance __ Unhappy at school
__ Nonpromotion in grades 1-3 __ Poor social skills
__ Constant Defiance of Rules
__ Frequent Discipline Referrals/Action
B. SCHOOL ATTENDANCE __ Fighting
__ Cheating
__ Absenteeism __ Excessive Nervousness
__ Tardy (__ Times to Date) __ Withdrawn (Loner)
__ On Absentee List but Seen in School __ Verbal Abuse
__ Frequently Requesting to be Out of __ Frequent Crying
Class (Trips to Restroom, etc.) __ Excessive Forgetfulness
__ Frequent Visits to Nurse or __ Frequently Tired
Counselor __ Talks Freely About Drug/Alcohol Use
__ Erratic Behavior/Mood Swings
__ Change in Friends
C. PHYSICAL SYMPTOMS __ Change in Appearances
__ Sudden Popularity
__ Basic nutritional/clothing needs __ Older Social Group
not met __ Disoriented Sense of Time
__ Sleeping in Class __ Carries Large Amounts of Money
__ Frequent Physical Complaints __ Depression
__ Frequent Physical Injuries __ Acts Defensive
__ Staggering or Stumbling __ Increasing Non-Involvement
__ Smelling of Alcohol or Marijuana
__ Coordination Problems
__ Glassy, Bloodshot Eyes
__ Slurred Speech
If you think that this student is experiencing a problem(s) please indicate your estimation of the severity of the problem(s) on a scale of 1-10. (10 should be used for the [1mmost[0m serious, 1 for the [1mleast[0m serious). ___
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