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Brief Addiction Monitor - Post Treatment 1 Year

 Instructions 

This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. 

The questions generally ask about the past 30 days. 

Please consider each question and answer as accurately as possible. 

2. In the past 30 days, would you say your physical health has been? *This question is required.
3. In the past 30 days, how many nights did you have trouble falling asleep or staying asleep? *This question is required.
4. In the past 30 days, how many days have you felt depressed, anxious, angry or very upset throughout most of the day? *This question is required.
5. In the past 30 days, how many days did you drink ANY alcohol? *This question is required.
6. In the past 30 days, how many days did you have at least 5 drinks (if you are a man) or at least 4 drinks (if you are a woman)? [One drink is considered one shot of hard liquor (1.5 oz.) or 12- ounce can/bottle of beer or 5 ounce glass of wine.]
7. In the past 30 days, how many days did you use any illegal/street drugs or abuse any prescription medications? *This question is required.
8. In the past 30 days, how many days did you use Marijuana (cannabis, pot, weed)?
9. In the past 30 days, how many days did you use Sedatives/Tranquilizers (e.g., “benzos”, Valium, Xanax, Ativan, Ambien, “barbs”, Phenobarbital, downers, etc.)?
10. In the past 30 days, how many days did you use Cocaine/Crack?
11. In the past 30 days, how many days did you use other Stimulants (e.g., amphetamine, methamphetamine, Dexedrine, Ritalin, Adderall, “speed”, "crystal meth", “ice”, etc.)?
12. In the past 30 days, how many days did you use Opiates (e.g., Heroin, Morphine, Dilaudid, Demerol, Oxycontin, oxy, codeine (Tylenol 2,3,4), Percocet, Vicodin, Fentanyl, etc.)?
13. In the past 30 days, how many days did you use Inhalants (glues/adhesives, nail polish remover, paint thinner, etc.)?
14. In the past 30 days, how many days did you use other drugs (steroids, non-prescription sleep/diet pills, Benadryl, Ephedra, other over- the-counter/unknown medications)?
15. In the past 30 days, how much were you bothered by cravings or urges to drink alcohol or use drugs? *This question is required.
16. How confident are you in your ability to be completely abstinent (clean) from alcohol and drugs in the next 30 days? *This question is required.
17. In the past 30 days, how many days did you attend self-help meetings like AA or NA to support your recovery? *This question is required.
18. In the past 30 days, how many days were you in any situations or with any people that might put you at an increased risk for using alcohol or drugs (i.e., around risky “people, places or things”)? *This question is required.
19. Does your religion or spirituality help support your recovery? *This question is required.
20. In the past 30 days, how many days did you spend much of the time at work, school, or doing volunteer work? *This question is required.
21. Do you have enough income (from legal sources) to pay for necessities such as housing, transportation, food and clothing for yourself and your dependents? *This question is required.
22. In the past 30 days, how much have you been bothered by arguments or problems getting along with any family members or friends? *This question is required.
23. In the past 30 days, how many days were you in contact or spent time with any family members or friends who are supportive of your recovery? *This question is required.
24. How satisfied are you with your progress toward achieving your recovery goals? *This question is required.
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