Live in Active Addition or Early Recovery Survey Adapted From Life In Recovery Survey from Faces and Voices of Recovery 2019 Question Title * 1. What is your gender? Female Male Other Question Title * 2. How old are you? 12-17 18-20 21-35 36-50 51-65 66 and over Question Title * 3. Where do you currently live? Apartment I rent Condominium I rent Home I rent Halfway home or other sober living site Apartment or condominium or home I own With friends With family Currently incarcerated Currently receiving inpatient care Currently homeless Question Title * 4. What is your highest level of education Some high school or less High school graduate or GED Some college Associate degree Vocational degree or apprenticeship Bachelor’s degree Graduate degree Question Title * 5. What is your current marital status Now married or living in a partner relationship Divorced, separated, or widowed Never married Question Title * 6. Which best describes your current employment status? Employed Full-Time Employed Part-Time Unemployed Student Homemaker Retired Other Question Title * 7. Overall, how would you describe your physical health right now? Poor Fair Good Very Good Excellent Question Title * 8. Do you use tobacco products (e.g., smoking cigarettes or cigars, snuff)? Yes No Question Title * 9. Are you currently suffering with active addiction issues or in early recovery? Yes No Question Title * 10. If answered YES to Question 9, please complete the following questions about your addiction and early recovery, if answered NO, please submit this current survey and if desired complete our Life in Recovery Survey. Thank you: When in active addiction, which substance(s) is/was your primary problem? Alcohol only Drugs only Both drugs and alcohol Question Title * 11. For how long have/did you use(d) drugs and/or alcohol in years (under one year: enter 1)? Question Title * 12. When is the last time you drank alcohol or used drugs? (If you do not know the exact day enter ‘15’, if you do know the exact month enter ‘06’, if still actively using enter ‘11/11/1111’) Date Date Question Title * 13. Which category best describes how you define yourself now, with respect to your current/or recent alcohol and/or drug use? Still actively using In early recovery In medication-assisted recovery Question Title * 14. If in early recovery, how long have you been in recovery/recovered etc? Less than 1 month Between 1-3 months Between 3-5 months Between 5-10 months Between 1-2 years 2 years or more Question Title * 15. Have you ever gone to a treatment program such as detox, methadone clinic, DUI program, in- or out-patient to deal with drugs and/or alcohol program? Yes No Question Title * 16. Have you ever taken medications prescribed by a health care professional to deal with drug and/or alcohol problems (e.g., methadone, buprenorphine, Vivitrol – Do Not Include Medications for Mental Health)? Yes No Question Title * 17. If you answered YES to Question 16, otherwise skip to Question 18: Are you currently taking prescription medication to deal with drug and/or alcohol problems to support your recovery? Yes No Question Title * 18. Have you ever attended a 12-step addiction recovery meeting such as Alcoholics or Narcotics Anonymous? Yes No Question Title * 19. If you answered YES to Question 18, otherwise skip to Question 20: Are you currently attending 12-step addiction recovery meetings regularly (once a week or more often)? Yes No Question Title * 20. Have you ever attended a NON 12-step addiction recovery support group (e.g., LifeRing, SMART Recovery/Rational Recovery)? Yes No Question Title * 21. If you answered YES to Question 20, otherwise skip to Question 22: Are you currently attending these NON 12-step addiction recovery support groups regularly (once a week or more often)? Yes No Question Title * 22. Please indicate which of the following events/situations you experienced/engaged in WHILE IN ACTIVE ADDICTION (if NOT APPLICABLE please leave unckeched) Debts/bad credit/bankruptcy/Can’t pay bills Had a bank account Had good credit/restored credit I had my own place to live Owed back taxes Paid back personal debts Paid bills on time Paid taxes/paid back taxes Lost custody of children (other than through divorce) Participated in family activities Planned for the future (e.g., saving for retirement and taking vacations) Regained child custody from protective services or foster care Was a victim or perpetrator of domestic violence Volunteered in community and/or civic group Voted Contracted infectious disease (e.g., Hep C or HIV/AIDS) Exercised regularly Experienced untreated emotional/mental health problems Frequent Emergency Room visits (other than for any ongoing medical/mental condition) Frequent use of health care services (e.g., hospitals, clinics, doctors) Got regular dental check ups Had a primary care provider Took care of my health (e.g., got regular medical checkups, sought help if needed) Had no health insurance Got arrested Served jail or prison time Damaged property (your own and/or others) DWI Expunged my criminal record Got my driver’s license back Lost right to vote Lost/suspended driver’s license Had no involvement with criminal justice system Got off probation/parole Lost professional or occupational license Restored professional or occupational license Dropped out of school Got fired/suspended at work Frequently missed work or school Furthered my education and/or training Got good job/performance evaluations Started my own business Steadily employed Question Title * 23. Did any other significant events, good or bad, happen to you while in active addiction? (250 characters or less) Question Title * 24. Please indicate which of the following life and medical issues are most relevant to you in your current situation (if NOT APPLICABLE please leave unckeched) Living on streets Living with friends and family In jail or prison Can’t find place to live that I can afford Have good housing Do not have reliable transportation Use public transportation Walk and ride a bike often to get around Have good transportation Often go without food Have food more often than not Regularly have healthy food to eat Steadily employed Have given up trying to find work Have job but searching for a better one Think about getting more education Have returned to an occupational or education program Given up on my education Can’t figure out how to get medical treatment for my addiction Can’t figure out how to get medical treatment for my mental health issues Have health insurance Have primary care physician Received or receiving addiction treatment Received or receiving mental health treatment Have chronic physical health ailments (e.g., asthma, arthritis) In peer support group for my addiction In medication-support program for my addiction Lost touch with much of my family and friends In occasional contact with my family and friends Regularly connect with my family and friends Feel supported and helped in my current life Question Title * 25. What support or service would most benefit your current treatment and or recovery from addiction? (250 characters or less) Question Title * 26. Overall, how would you rate your quality of life? Poor Fair Good Very good Excellent Question Title * 27. Is there anything you would like to add about the costs of addictions and/or the benefits of recovery to your life? (250 characters or less) Done