Place a checkmark next to activities, situations, or settings in which you frequently used substances or; place a zero next to activities, situations, or settings in which you never have used substances 

   Home alone     Home with friends     Friend’s home     Parties     Sporting events     Movies     Bars/clubs       Playing cards 
   Beach     Concerts     With friends who use drugs    When gaining weight     Vacations/holidays     When it’s raining     Before a date
   During a date     Before sexual activities     During sexual activities     After sexual activities     Before work     When carrying money     After going past dealer’s residence    Driving     Liquor store     During work     Talking on the phone     Recovery groups     After payday       When gambling        At family events        During work
   Before going out to dinner
   Before breakfast     At lunch break     While at dinner       If I win money 
   After work     After passing a particular street or exit    School     The park     In the neighborhood     Weekends     With family members     When in pain       At the casino     

 
List any other  activities,  situations, or settings where  you frequently have used   
List activities,  situations, or settings in which you would not use or gamble     
List people you could  be  with and  not use.