Home Accessing Support Questionnaires Christo Inventory for Substance-misuse Services Christo Inventory for Substance-misuse Services Contact Information First Name * Last Name * Date Of Birth * Telephone Number * Email Address * Reference 1. Social Functioning I have a stable place to live and supportive friends or relatives who are drug/alcohol free. My living situation is not completely stable; I sometimes associate with drug users or heavy drinkers. My living situation is not stable. I have few friends other than drug users or heavy drinkers. 2. General Health I have no significant health problems. I have moderate health problems e.g., teeth/sleep problems, occasional stomach pain, collapsed vein, asymptomatic hep B/C/HIV. I have major health problems e.g. extreme weight loss, jaundice, abscesses/infections, coughing up blood, fever, overdoses, blackouts, seizures, significant memory loss, neurological damage, HIV symptoms. 3. Sexual/injecting risk behaviour I do not to inject, or have unsafe sex (except in monogamous relationship with longstanding partner, spouse). I occasionally have 'unsafe' sexual encounters or inject but I don't share injecting equipment. I sometimes have 'unsafe' sexual encounters or have been injecting and sharing injecting equipment 4. Psychological I think I am well adjusted and relatively satisfied with the way my life is going. I think I may have low self-esteem, general anxiety, poor sleep, and am unhappy or dissatisfied with my lot. I have a neurotic disorder e.g., panic attacks, phobias, OCD, bulimia, recently attempted or I have seriously considered suicide, self-harm, overdose or may be clinically depressed. Or I may have psychotic disorders, paranoia (e.g., everybody is plotting against me), deluded beliefs or hallucinations (e.g. hearing voices). 5. Occupation I am in a full time occupation e.g., homemaker, parent, employed, or student. I have some part time parenting, occupation or voluntary work. I am largely unoccupied with any socially acceptable pastime. 6. Criminal involvement I have no criminal involvement (apart from possible possession of illicit drugs for personal use). I have been suspected of irregular criminal involvement, like petty fraud, petty theft, drunk driving, small scale dealing. I have been suspected of regular criminal involvement, or breaking and entering, car theft, robbery, violence, assault. 7. Drug/alcohol use I have not recently used drugs or alcohol. I sometimes use drugs or alcohol alone or socially but not in ways that are considered a problem. I do not supplement prescribed from other sources. I am a binge drinker or regularly use drugs or alcohol. 8. Ongoing support I regularly attend AA/NA, a drug-free drop in centre, day centre, or have counselling or treatment aftercare. I sometimes (less than once a week) have contact with at least one of AA/NA, a drug-free drop in centre, day centre, or have counselling or treatment aftercare. I don't use any type of structured support. 9. Compliance I am good at attending all appointments and meetings on time, following suggestions, and complying with treatment requirements. Some people think I am not very reliable, or may have an 'attitude problem' or other difficulties with staff. I'm pretty chaotic. I have left treatment against staff advice or been ejected for non-compliance e.g. drug use, attitude problem. 10. Working Relationship I'm relatively easy going, relaxed at interviews and don't waste peoples' time or stress them out. Some people seem to think I am a little bit demanding or time consuming. People find me challenging e.g., very demanding, hard work, time consuming, emotionally draining or stressful to see. If you are a real user, leave this field blank Send Form Posted on 19 September 2020 at 7:03 pm.