Assessment of Recovery Capital
Please enter the number you were given. Please be sure you enter the correct number
1. Peer number:
2. I am currently completely sober
Clear selection
3. I feel I am in control of my substance use.
Clear selection
4. I have had no "near things" about relapsing.
Clear selection
5. I have had no recent periods of substance intoxication.
Clear selection
6. There are more important things to me in life than using substances.
Clear selection
7. I am able to concentrate when I need to
Clear selection
8. I am coping with stresses in life
Clear selection
9. I am happy with my appearance
Clear selection
10. In general I am happy with my life
Clear selection
11. What happens to me in the future mostly depends on me
Clear selection
12. I cope well with everyday tasks
Clear selection
13. I feel physically well enough to work
Clear selection
14. I have enough energy to complete the tasks I set myself
Clear selection
15. I have no problems getting around
Clear selection
16. I sleep well most nights
Clear selection
17. I am proud of the community I live in and feel part of it-sense of belonging
Clear selection
18. It is important for me to contribute to society and or be involved in activities that contribute to my community
Clear selection
19. It is important for me to do what I can to help other people
Clear selection
20. It is important for me that I make a contribution to society
Clear selection
21. My personal identity does not revolve around drug use or drinking
Clear selection
22. I am happy with my personal life
Clear selection
23. I am satisfied with my involvement with my family
Clear selection
24. I get lots of support from friends
Clear selection
25. I get the emotional help and support I need from my family
Clear selection
26. I have a special person that I can share my joys and sorrows with
Clear selection
27. I am actively involved in leisure and sport activities
Clear selection
28. I am actively engaged in efforts to improve myself (training, education and/or self awareness)
Clear selection
29. I engage in activities that I find enjoyable and fulfilling.
Clear selection
30. I have access to opportunities for career development (job opportunities, volunteering, or apprenticeships)
Clear selection
31. I regard my life as challenging and fulfilling without the need for using drugs or alcohol.
Clear selection
32. I am proud of my home
Clear selection
33. I am free of threat or harm when I am at home
Clear selection
34. I feel safe and protected where I live
Clear selection
35. I feel that I am free to shape my own destiny
Clear selection
36. My living space has helped to drive my recovery journey
Clear selection
37. I am free from worries about money
Clear selection
38. I have the personal resources I need to make decisions about my future
Clear selection
39. I have the privacy I need
Clear selection
40. I make sure I do nothing that hurts or damages other people
Clear selection
41. I take full responsibility for my actions
Clear selection
42. I am happy dealing with a range of professional people
Clear selection
43. I do not let other people down
Clear selection
44. I eat regularly and have a balanced diet
Clear selection
45. I look after my health and wellbeing
Clear selection
46. I meet all of my obligations promptly
Clear selection
47. Having a sense of purpose in my life is important to my recovery journey
Clear selection
48. I am making good progress on my recovery journey
Clear selection
49. I engage in activities and events that support my recovery
Clear selection
50. I have a network of people I can rely on to support my recovery
Clear selection
51. When I think of the future I feel optimistic
Clear selection
Thank you so much for taking the time to fill out this survey! You are helping us out a lot!
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This form was created inside of The Center for HOPE. Report Abuse