Hello, I would like to take a few minutes to ask you some questions about you as a person and your experiences. Everything is confidential. Please be honest with your responses. After the surveys are conducted, we will combine everyone’s responses when presenting the final report. For example, we would never say, “Joe Smith said that...” but rather, we would say, “overall, participants in ASAC report that…”

Please answer the following question in your own words:

  1. Overall, what are the biggest problems in your life right now?
  1. What do you think led to your successful completion in ASAC?
  1. What helped you stay clean this time, compared to other times in the past where you tried to stop using?
  1. What did you like best about the program?
  1. What did you like least about the program?
  1. Other Comments?

Please rate your agreement or disagreement on a 1-5 scale where 1 = strongly disagree and

5 = strongly agree and 3 = neither agree nor disagree.

Strongly disagree Strongly Agree

I can effectively deal with daily problems. / 1 2 3 4 5
I feel good about myself. / 1 2 3 4 5
I am able to control my life. / 1 2 3 4 5
I experience harmful medication side effects (if applicable). / 1 2 3 4 5 / N/A
I am able to deal with crisis. / 1 2 3 4 5
I get along with my family. / 1 2 3 4 5
I do well in social situations. / 1 2 3 4 5
I do well with my schoolwork (if applicable). / 1 2 3 4 5 / N/A
I do well with my free time. / 1 2 3 4 5
I am satisfied with my housing situation. / 1 2 3 4 5
My mental health symptoms do not bother me very much (if applicable). / 1 2 3 4 5 / N/A
I am pretty independent. / 1 2 3 4 5
Most of my close friends are drug users. / 1 2 3 4 5
Most of my close friends engage in criminal behavior. / 1 2 3 4 5
The medications I am taking help me control symptoms that used to bother me (if applicable). / 1 2 3 4 5 / N/A
I am effective in getting what I need. / 1 2 3 4 5
I can effectively deal with people and situations that are problems for me. / 1 2 3 4 5
I am satisfied with my employment situation. / 1 2 3 4 5
I am satisfied with my financial situation. / 1 2 3 4 5
I am connected to help in the community. / 1 2 3 4 5

Name:______

Graduate Survey

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