Drug Addiction Help For The Residents of Wyoming this is a free service to the public

  Drug Treatment Program

This online service is provided free of charge as a public benefit service to the residents of Wyoming and all information received from clients is confidential. Response time is usually 24 hours or less, and is in the form of a confidential e-mail. In some instances phone contact may be appropriate and necessary to better assess the situation, or in the case of an emergency where the call was requested by the individual. In the event of a phone call the counselor will only identify themselves to the contact person listed below, and will advise all others that this is a personal call and will not disclose who we are or why we are calling.

In assessing the problem and deciding on treatment options, several factors that are typically used in assessing an individual's level of addiction. These factors include:

  • Prior alcohol and drug use history;

  • Family history and Ethnic/Cultural background;

  • Social history;

  • Legal history;

  • Educational history;

  • Occupational history;

  • Medical history;

  • Psychological and behavioral problems. 

All information submitted will be deleted once we have contacted you and helped you get into the Inpatient Drug or Alcohol Treatment Program you were needing for either yourself or a loved one. 

Contact information: Fill out the Form below and we will Contact you ASAP.
 My Name is, First & Last
 My Phone Number and area code
My e-mail address is:
Best time to call is, am  pm: Pacific-time, Mountain-time, Central-time, Eastern-time:
A). Medical History:

drugs and alcohol addictionDoes the individual have any medical problems? (Please describe)

drugs and alcohol addiction Is the individual currently taking any medications?  yes  no

     If yes, please specify what the length of time used:

B). Legal History:

drugs and alcohol addictionDoes the individual have a valid drivers license?  yes  no

drugs and alcohol addictionHas the individual ever been arrested? (If so, for what)

drugs and alcohol addictionAre any crimes actively being committed to support, or as a result of the alcoholism or addiction?

C). Substance Abuse History:

drugs and alcohol addictionAt what age did the individual start using the substance?:


drugs and alcohol addictionDifferent drugs used:

drugs and alcohol addictionMethod of use:  
  Oral     IV-(Inject)     inhale(Smoke)     nasal(Snort)      other

drugs and alcohol addictionPast treatment attempts (What rehab, when, results:

D). General Contact Information: 

drugs and alcohol addictionYour Relation to the Alcoholic/Addict:

drugs and alcohol addictionAlcoholics/Addicts Name:

drugs and alcohol addictionCity and State in which they live:

drugs and alcohol addictionCan they travel outside of this area for treatment?  yes  no

drugs and alcohol addictionHow old is the addict ?

drugs and alcohol addictionCurrent drug (s) their using:

Question/Comment/How can we help you:

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Drug Rehab Services is a Drug Rehabilitation help service for Wyoming residence , we can help you. Our counselors will talk to you and give helpful advice. We have been there! 
The help line is a service that is free to the public to help with the process of getting someone into Treatment for Addiction that will work!