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. Send Form Posted on 19 September 2020 at 7:03 pm.