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L. Ron Hubbard and the Narconon Program
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Methodology of The Narconon Program
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Contact Narconon Arrowhead
Drug FactYour Name:
Drug FactEmail :
Drug FactPhone #:
Drug FactAddress:
Drug FactCity: Drug FactState:
Drug FactPostal Code:

Drug FactPerson you wish to help ? self other 
      If other, who are you concerned about: 
      Name:  Relationship:

Drug FactHow old is the addict ? 

Drug FactDoes the addict want help ? yes no 

Drug FactPlease list drugs abused: 
Drug FactPrimary:
Drug FactSecond:
Drug FactThird:

Drug FactHow does the addict obtain drugs/alcohol ? 
     Works  Steals  Prescription  Deals  Other

Drug FactPlease describe any personal / family problems the addict has.
     

Drug FactPlease describe any legal problems the addict has.
     

Drug FactPlease describe the overall behavior & condition of the addict.
     

Drug FactIs there any diagnosed medical condition? (Please describe)
     

Drug FactIs there any diagnosed mental disorder? (Please describe)
     

Drug FactDid the addict on any medication for any of the above? 
     yes no 
      Medication?  How long? 

Drug FactHas the person ever attempted to stop using drugs before ?
     yes no 

      If so, by which method?
     Self  12-step  Non-Hospital Residential  Hospital  Other

Drug FactIf the addict has received treatment, please describe? (Include name of the facility, 12-step, etc.)
     

Drug FactWas it a private program or a state-funded program ? 
     private state-funded 

Drug FactWas there any success with the prior treatment ? (How long did the addict stay clean, etc?)
     

Drug FactIs there anything else you would like us to know?
     

     

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