Anti-diabetic assessment of Solutions #396 to #401 Testing Institution Diabetes Discovery Platform, South African Medical Research Council, Tygerberg, 7505, South Africa. 22 December 2008 Testing Institution Diabetes Discovery Platform, South African Medical Research Council, Tygerberg, 7505, South Africa. OBJECTIVE To investigate the in vitro glucose uptake
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Proposed new participant survey questions:Participant Survey Questions:
Today’s Date: ____/_____/_____
Important Note: This information is collected only for demonstrating how well Recovery Centers
work. We are committed to protecting our visitors’ identities and anonymity. (Edited 8-28-12)
Please answer all questions as completely and accurately as you can.
Gender: male female
Date of birth ____/____/____
1) Is your attendance at the recovery center based on your drug and alcohol use/addictions? Yes or No 2) Is your interest in recovery based on someone else’s substance use/addictive behaviors? . Yes or No 3) How long have you been coming to the recovery center? . ___years ___months ___days 4) How long have you been sober and/or in recovery from drug/alcohol use? . ___years ___months ___days 5) How many times a month do you come to the recovery center? ____ 6) Came to attend meeting/training at center Referred by detox/Public Inebriate Program 7) Have you attended Making Recovery Easier? Please check one: Yes, I have started attending sessions No, I have not attended any Making Recovery Easier group sessions. 8) Have you had problems with returning to use after trying to stop? . Yes or No
9) Has the recovery center helped you reduce the frequency of relapses? . Yes or No
10) Has the recovery center helped you reduce the length of relapses? . Yes or No
11) Have you been in substance abuse treatment? (include counseling as treatment) . Yes or No
12) Have you been in treatment during the last 30 days? . Yes or No
13) Have you participated in outpatient/inpatient mental health services? . past present never 14) Are you involved in activities at the recovery center? Please check all that apply: Fellowship (meeting/hanging with friends) 15) Has the recovery center helped you to find your recovery? . Yes or No
16) Has coming to the center helped you to maintain your recovery? . Yes or No
17) Has participating in the center’s activities enhanced your recovery experience? . Yes or No
18) Since coming to the center has your overall health and wellness improved? . Yes or No 19) Since coming to the center have you started or increased physical exercise? . Yes or No 20) Since coming to the center have you decreased or stopped smoking? . Yes No N/A 21) Since coming to the center have your family relationships (partner, spouse, children) 22) Current housing — please check one: Rent residence or a room in a shared apartment 23) Have you found housing since coming to the center? . Yes or No 24) Did people, support, or information provided at the center help you to find housing?. . Yes No N/A 25) Current employment status — please check one: Part-time employed (less than 35 hours/week) 26) Have you found work since coming to the center?. Yes No N/A 27) Did people, support, or information provided at the center help you to find work? . Yes No N/A 28) Are you receiving any forms of assistance? Please check all that apply: 29) Criminal justice system involvement — please check one: Never involved with criminal justice system 30) Did you have “incidents” or criminal involvement before getting involved with the center? . Yes or No
31) Did you have new “incidents” or criminal involvement since getting involved with the center?Yes or No
32) In the past 30 days, have you been in crisis and used any of the following services? Please check all Mental Health Crisis Team (”screeners”) 33) Are you currently taking prescribed medications in support of your health and recovery? Please check all Thank you for your valuable time and help!
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