We know that alcohol, cigarette, inhalant, and drug use can affect a young person’s physical growth, emotional development, school performance, and health. We agree that I, __________________________________, will not drink alcohol or use any other harmful or illegal substances. Our plan for preventing substance use problems includes what to do in risky situations and what the consequences are for substance use.

Risky situations

In risky situations, we agree to the following:

• If offered a substance (alcohol, cigarettes, inhalant, or drugs), I will:
• If I am at an event where alcohol or drugs are being used, I will:
• If offered a ride from someone who has been using drugs or drinking, I will:
• Other risky situations that we have identified include:

Consequences

We agree to the following:

• If I smoke, the consequence will be:
• If I use an inhalant, the consequence will be:
• If I drink alcohol, the consequence will be:
• If I take other drugs, the consequence will be:
• If I ride with a driver who is or has been drinking or using drugs, the consequence will be:
• If I drive after or while drinking alcohol or using other drugs, the consequence will be:
• If I continue to drink alcohol or use other substances, the consequence will be:
• If I develop signs of substance use disorder, the consequence will be: