Sunday, April 14, 2013

Proximity to substance abuse scale

What is the client's proximity to substance abuse?

Neither agree
nor disagree

Using the above scale, please indicate the degree to which you agree or disagree with the following statements.

Please read each question and answer honestly. Your answers will be kept strictly confidential.

___1. I believe that a close friend or family member currently uses alcohol or other drugs to help them avoid uncomfortable feelings.

___2. I was with a significant other in the last five years who used drugs or alcohol in a problematic way.

___3. A close friend or relative sold drugs in the past five years.

___4. A close friend or relative becomes intoxicated on a measurable basis.

___5. I have felt uncomfortable about a friend or family member's relationship to intoxication.

___6. Alcohol or other drugs are nearly always part of my social interactions.

___7. A close friend or relative has experienced more than two consequences directly due to their relationship to being intoxicated.
___8. Most of my friends become intoxicated with alcohol or another drug on a regular basis.

___9. Frequently I come in close contact with people who sell drugs.

___10. I personally know several people who use would benefit by quitting or limiting alcohol or other drug use.

___11. Alcohol or other drugs are usually close by when I have a good time.

___12. When I was young, alcohol or other drugs were nearly always present at family functions.

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