Adapted From Life In Recovery Survey from Faces and Voices of Recovery 2019

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* 1. What is your gender?

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* 2. How old are you?

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* 3. Where do you currently live?

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* 4. What is your highest level of education

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* 5. What is your current marital status

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* 6. Which best describes your current employment status?

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* 7. Overall, how would you describe your physical health right now?

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* 8. Do you use tobacco products (e.g., smoking cigarettes or cigars, snuff)?

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* 9. Are you currently suffering with active addiction issues or in early recovery?

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* 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?

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* 11. For how long have/did you use(d) drugs and/or alcohol in years (under one year: enter 1)?

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* 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’)

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* 13. Which category best describes how you define yourself now, with respect to your current/or recent alcohol and/or drug use?

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* 14. If in early recovery, how long have you been in recovery/recovered etc?

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* 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?

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* 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)?

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* 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?

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* 18. Have you ever attended a 12-step addiction recovery meeting such as Alcoholics or Narcotics Anonymous?

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* 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)?

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* 20. Have you ever attended a NON 12-step addiction recovery support group (e.g., LifeRing, SMART Recovery/Rational Recovery)?

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* 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)?

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* 22. Please indicate which of the following events/situations you experienced/engaged in WHILE IN ACTIVE ADDICTION (if NOT APPLICABLE please leave unckeched)

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* 23. Did any other significant events, good or bad, happen to you while in active addiction? (250 characters or less)

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* 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)

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* 25. What support or service would most benefit your current treatment and or recovery from addiction? (250 characters or less)

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* 26. Overall, how would you rate your quality of life?

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* 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)

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