Proposed new participant survey questions:

Participant Survey Questions:
Today’s Date: ____/_____/_____
Important Note: This information is collected only for demonstrating how well Recovery Centers
work. We are committed to protecting our visitors’ identities and anonymity. (Edited 8-28-12)
Please answer all questions as completely and accurately as you can.

Initials ____/____/____
Gender: male  female 
Date of birth ____/____/____
1) Is your attendance at the recovery center based on your drug and alcohol use/addictions? Yes  or No  2) Is your interest in recovery based on someone else’s substance use/addictive behaviors? . Yes  or No  3) How long have you been coming to the recovery center? . ___years ___months ___days 4) How long have you been sober and/or in recovery from drug/alcohol use? . ___years ___months ___days 5) How many times a month do you come to the recovery center? ____ 6) Came to attend meeting/training at center Referred by detox/Public Inebriate Program  7) Have you attended Making Recovery Easier? Please check one: Yes, I have started attending sessions  No, I have not attended any Making Recovery  Easier group sessions. 8) Have you had problems with returning to use after trying to stop? . Yes  or No 
9) Has the recovery center helped you reduce the frequency of relapses? . Yes  or No 
10) Has the recovery center helped you reduce the length of relapses? . Yes  or No 
11) Have you been in substance abuse treatment? (include counseling as treatment) . Yes  or No 
12) Have you been in treatment during the last 30 days? . Yes  or No 
13) Have you participated in outpatient/inpatient mental health services? . past  present  never  14) Are you involved in activities at the recovery center? Please check all that apply: Fellowship (meeting/hanging with friends)  15) Has the recovery center helped you to find your recovery? . Yes  or No 
16) Has coming to the center helped you to maintain your recovery? . Yes  or No 
17) Has participating in the center’s activities enhanced your recovery experience? . Yes  or No 
18) Since coming to the center has your overall health and wellness improved? . Yes  or No  19) Since coming to the center have you started or increased physical exercise? . Yes  or No  20) Since coming to the center have you decreased or stopped smoking? . Yes  No  N/A  21) Since coming to the center have your family relationships (partner, spouse, children) 22) Current housing — please check one: Rent residence or a room in a shared apartment  23) Have you found housing since coming to the center? . Yes  or No  24) Did people, support, or information provided at the center help you to find housing?. . Yes  No  N/A  25) Current employment status — please check one: Part-time employed (less than 35 hours/week)  26) Have you found work since coming to the center?. Yes  No  N/A  27) Did people, support, or information provided at the center help you to find work? . Yes  No  N/A  28) Are you receiving any forms of assistance? Please check all that apply: 29) Criminal justice system involvement — please check one: Never involved with criminal justice system  30) Did you have “incidents” or criminal involvement before getting involved with the center? . Yes  or No 
31) Did you have new “incidents” or criminal involvement since getting involved with the center?Yes  or No 
32) In the past 30 days, have you been in crisis and used any of the following services? Please check all Mental Health Crisis Team (”screeners”)  33) Are you currently taking prescribed medications in support of your health and recovery? Please check all Thank you for your valuable time and help!

Source: https://vtrecoverynetwork.org/PDF/Participant_Survey_Questions.pdf