Drug & Alcohol Relapse Assessment

Fill this out if you are serious about joining the group, would like to see if what you seek matches what the group offers. If there is a match, this will become part of your record. Mostly, I am trying to gauge your experience and where it has brought you.

Name
Email
Phone
Have you ever decided to quit drinking/drugging, quit for a time, only to start again?
If so, how many times?
What is your longest period of abstinence from drugs/alcohol since first deciding to quit?
The last time you were abstinent and decided to take that very first drink or drug, what were you telling yourself about it at that moment?
Are you willing to commit to a minimum of eight weekly group sessions?
Are you willing to do “homework” every week and share what you learn from it?
Are you willing to share and/or receive non-judgmental perceptions about your drinking/use and that of group members? (We do NOT attack or “call BS.”)
Are you currently clean and sober?
How long?
Are you willing and able to remain abstinent between weekly meetings?
What has your “drug of choice” been in the past year?
My understanding of how I decided to pick up that first drink/drug again is