60 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER B. The client has displayed increased anxiety, unstable affect, and disorganiz ation as a result of withdrawal from mood-altering illicit substances. C. As the client has terminated his/her use of mood-altering illicit substances, his/her experience of secondary psychosis symptoms has decreased significantly. 5. Inability to Reduce Alcohol/Drug Abuse (3) A. The client acknowledged that he/she frequently has attempted to terminate or reduce his/her use of mood-altering substances but found that he/she has been unable to follow through. B. The client acknowledged that in spite of ne gative consequences and a desire to reduce or terminate the mood-altering substances, he/she has been unable to do so. C. As the client has participated in a total recovery program, he/she has been able to maintain abstinence from mood-altering drug use. 6. Negative Blood Effects (4) A. The client's blood work results reflect a pattern of heavy substance use in that his/her liver enzymes are elevated. B. The client's blood work results indicate that mood-altering drugs have been used. C. As the client has participated in the recovery program and has been able to maintain abstinence from mood-altering substances, his/her blood work has shown no evidence of ongoing substance abuse. 7. Denial (5) A. The client presented with denial regarding the negative consequences of his/her substance abuse, in spite of direct feedback from others about its negative impact. B. The client's denial is beginning to break down as he/she is acknowledging that substance abuse has created problems in his/her life. C. The cl ient now openly admits to the severe negative consequences brought on by his/her substance abuse. 8. Persistent Alcohol/Drug Abuse Despite Problems (6) A. The client has continued to abuse alcohol and/or drugs in spite of recurring physical, legal, vocat ional, social, or relationship problems that were directly caused by the substance use. B. The client has denied that the many problems in his/her life are directly caused by substance abuse. C. The client acknowledged that substance abuse has been the c ause of multiple problems in his/her life, and he/she verbalized a strong desire to maintain a life free from using all mood-altering substances. D. As the client has maintained sobriety, some of the direct negative consequences of substance abuse have di minished. E. The client is now able to face resolution of significant problems in his/her life as he/she has begun to establish sobriety. 