Substance Use Recovery Progress Survey Form
Share your recovery progress, recent challenges, supports, and goals. Please keep responses focused on general progress and not on sensitive medical details.
Survey Details
Preferred name or alias
*
Current recovery stage
*
Starting out
Early recovery
Maintaining progress
Long-term recovery
Not sure yet
Other
Time in recovery
*
Please Select
Less than 1 month
1-3 months
3-6 months
6-12 months
1+ years
Recent Experience
Days Since Last Use or Setback
*
Strongest Triggers Experienced Recently
*
Stress
Conflict with others
Social pressure
Anxiety or low mood
Boredom
Fatigue
Being around substances
Sleep problems
Pain or discomfort
Other
Most Helpful Supports Used Recently
*
Counseling or therapy
Support group meeting
Talking with a trusted person
Exercise or movement
Journaling or reflection
Mindfulness or breathing exercises
Healthy routine or structure
Crisis or peer support line
Other
Goals and Support
Main goal for the next 30 days
*
How much support do you need right now?
*
A little
Some
A lot
Not sure
Anything else you'd like to share about your progress
Submit Survey
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