Exit this survey

1. Default Section

* 1. Date of Birth

2. Are you still in treatment today?

3. When was your earliest experience of bieng a victim of domestic violence, abuse, or trauma? (looking for an age)

4. In your opinion when was it that you first recognized that you were involved in a relationship that had characteristics of domestic violence?

5. How did your the domestic violence in your relationship unfold?

6. What was your drug of choice?

7. What was your first substance related experience and with whom did it occur and in response to what if anything? (looking for an age and relation - friend or family member

8. WHen did you first start using?

9. What time in your life did your active use of substances begin?

10. Did your use become more intense with abuse?

11. When was your earliest experience with a mental health problem?

12. How did your diagnosis unfold?

13. What do you believe influenced or caused these experiences to occur?

14. What do you see being at the core root of your experiences?

15. WHat influenced or caused your experience to occur?

16. If you could explain a timeline of life experiences what would it look like? (Looking for what came first, second, third)

17. What consequences did these issues have on you?

18. When did you seek help for your mental health concerns, or have you not yet sought help, and what were your symtoms like?

19. Were you still involved in the relationship with characteristics of domestic violence when you sought help?

20. What strategies were offered to you during the process?

* 21. What strategies were you encouraged to implement during the process?

22. What came from what was offered to you?

23. What do you believe was the most important intevention given to you?

24. How did that impact all of the issues?

25. What was the worst thing that occurred during treatment that impacted you?

26. What would the perfect treatment to meet all of your needs look life if you could create it?