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Rehab

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9 views

Rehab

Uploaded by

jeevithcrypto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Name: Date:

Age: Sex:

The following questionnaire contains 25 Statements, read each statements carefully and mark how
frequently you have had that thought, or a thought similar to it, ranging from: Always (4), Frequently (3),
Sometimes (2), Rarely (1), Never (0). After you are done answering, tally the marks to calculate the raw
scores to draw interpretations.

The answers will be kept confidential. There is no right or wrong answer. There is no time limit, but try to
answer these questions as fast as you can.

Sl.no Statements Always Frequently Sometimes Rarely Never


1. "One drink/line/hit won't matter."
2. "I've already messed up, so why bother
trying?"
3. "I can handle it this time."
4. "Everyone else is having fun, and I'm
missing out."
5. "I can't handle this stress without using."
6. "I feel so bad, I need to use to feel better."
7. "I'm bored, so I'll use to entertain
myself."
8. "I'm angry, and using will make me calm
down."
9. "I'm a failure for relapsing."
10. "I'm too weak to resist."
11. "I don't need anyone, I can handle this
alone."
12. "My friends/family don't understand me."
13. "It's not that bad, I can control it."
14. "I don't have a problem."
15. "I deserve a reward for staying clean."
16. "Everyone else is doing it, they’re fine."
17. “I’m not seeing any results fast enough.”
18. "I can quit anytime I want."
19. "I'm under too much stress, I need to
relax."
20. "Using will help me focus and be
productive."
21. "Things were better when I was using."
22. "I can handle it this time."
23. “I might as well go all the way.”
24. “Who am I even doing this for?”
25. “Nobody cares if I’m sober.”
Raw Score
Interpretations:

1. 0-30: Low relapse risk. The individual likely has strong coping mechanisms and a positive outlook on
recovery.

· Reinforcement of coping skills: Continue to build upon existing strengths and coping mechanisms.
· Relapse prevention planning: Develop a personalized relapse prevention plan.
· Support group participation: Encourage involvement in support groups for continued support and
accountability.

2. 31-60: Moderate relapse risk. The individual may experience fluctuations in their recovery process and
require additional support.

· Cognitive-behavioral therapy (CBT): Address negative thought patterns and develop healthier coping
strategies.
· Emotion regulation techniques: Teach individuals to manage and express emotions effectively.
· Stress management training: Equip individuals with tools to manage stress and avoid triggers.

3. 61-80: High relapse risk. The individual is likely struggling with significant challenges and requires
intensive therapeutic intervention.

· Intensive outpatient or residential treatment: Consider more structured treatment settings.


· Medication-assisted treatment (MAT): Explore the potential benefits of medication for managing
withdrawal symptoms and cravings.
· Family therapy: Involve family members in the treatment process to provide support and education.

4. 81-100: Very high relapse risk. The individual is at immediate risk of relapse and needs urgent
professional assistance.

· Immediate crisis intervention: Address urgent needs and safety concerns.


· Hospitalization: Consider inpatient treatment for medical stabilization and intensive therapy.
· Medication-assisted treatment (MAT): Rapidly initiate MAT to stabilize the individual.

*This questionnaire is not intended as an alternative/replacement for professional consultation.*

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