Relapse Self Test

Abundant Health Recovery And Wellness Center

Here is a simple list of questions that indicate relapse symptoms. Answer and submit these questions and the Director will review them confidentially and contact you with her findings.
Full Name:*
eMail:*
Phone:

1.	Do you feel you have a lack of personal confidence to remain clean/sober or abstinent?	Yes	No
2.	Do you find yourself trying to convince yourself or others that you will never ever drink or use again?	Yes	No
3.	Do you become defensive when talking about your problem in recovery?	Yes	No
4.	Are you experiencing periods of loneliness?	Yes	No
5.	Are you experiencing periods of depression?	Yes	No
6.	Do you over-react, or are impulsive behaviors beginning to appear?	Yes	No
7.	Are you behaving irrationally with friends and family?	Yes	No
8.	Are you experiencing a loss in the ability to plan constructively where attention to details lessen and wishful thinking begins?	Yes	No
9.	Do you feel you have an inability to concentrate, feel full of anxiety, or have feelings of being trapped?	Yes	No
10.	Have you had increasingly irregular attendance at recovery meetings?	Yes	No
11.	Are you having thoughts of social drinking/using?	Yes	No
12.	Have you discontinued attendance at Recovery Meetings altogether?("Developed an I do not need them attitude"?)	Yes	No
13.	Have you started "controlled" drinking and using?	Yes	No