Research Survey & Questionnaire Completion

Research Questionnaire

Have you been diagnosed with Substance Use Disorder? Have you attended a Self-Help Group for treatment?

Thank you for your participation in this research to identify the helpful aspects of Self-Help Groups in maintaining sobriety.

What is your gender?

Male Female  

Please select your age group.

18-25 25-35 35-45 45-55 55 or over

What type of Self-Help Group did you attend?

AA? 12-Step Therapy? Yes | No

Individual/Group Therapy? Yes | No

Other form of Self-Help Group therapy? Yes | No

Please rate the quality of your experience in the Self-Help Group.

1 2 3 4 5

Disappointing Exceptional

Please rate the quality of material covered in the Self-Help Group.

1 2 3 4 5

Disappointing Exceptional

Was your time utilized properly?

1 2 3 4 5

Disappointing Exceptional

Please rate your overall experience.

1 2 3 4 5

Disappointing Exceptional

How frequently do you visit the Self-Help Group?

3-5 times per week 1-2 times per month

Once every week Other

 

 

Research Questionnaire

 

 

Continued

 

Do you plan to return to the Self-Help Group?

Yes | No

 

Would you recommend the Self-Help Group to a friend?

 
Yes | No  

Why, or why not?

 
   
   

If your visit was successful, what can you attribute to the success?

 
   
   

What can you attribute to the success of your sobriety?

 
   
   

 

Please share any additional comments or suggestions.