Questionaire for Past Clients

Overall, how often do you feel like using ( post treatment)






After you completed treatment, when you felt like using, how often did you actually use?






How long after you completed treatment did your first use occur?








If you used after treatment, on average, how much of the substances did/do you use?






Compared to before treatment, to what extent have you engaged in the following?

Impaired Driving






Compared to before treatment, to what extent have you engaged in the following?

Needle Sharing






Compared to before treatment, to what extent have you engaged in the following?

Legal or Justice System ( Criminal Activity)






Compared to before treatment, to what extent have you engaged in the following?

Violent Activity






Compared to before treatment, to what extent have you participated in the following healthy and healing activities?

Addiction Support Group






Compared to before treatment, to what extent have you participated in the following healthy and healing activities?

Cultural/Social Activities






Compared to before treatment, to what extent have you participated in the following healthy and healing activities?

Spiritual Activities






Compared to before treatment, to what extent have you participated in the following healthy and healing activities?

Healthy & Physical Activities






Compared to before treatment, to what extent have you participated in the following healthy and healing activities?

Mental Health Supports






Since completing treatment, please indicate to what extent you agree/disagree with the following:

My overall physical health has improved.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I am better able to face the challenges in my life.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I have more control over my life.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I have better or improved positive relations with the people around me.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I am better able to ask for help or support when I need it.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I am seeking support from at least one person.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I have more to contribute to society.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I feel my community is supportive of my recovery.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I am more comfortable with my current living situation.







Since completing treatment, please indicate to what extent you agree/disagree with the following:

I am more ready to improve my education and/or employment status if opportunities are available.