1. Have you used your primary drug of concern? --None-- Several times a day Daily Most days of the week 1 -2 times a week Not at all

Drugs: Alcohol Cannabis Amphetamines Other

If relevant, please specify:

2. Have you used other drug/s of concern: --None-- Several times a day Daily Most days of the week 1 -2 times a week Not at all

Drugs: Alcohol Cannabis Amphetamines Other

If relevant, please specify:

3. How has your physical health been?: --None-- Very poor Fair Satisfactory Good Very Good

4. How has your mental health been? (e.g. your emotional wellbeing/stress level) --None-- Very poor Fair Satisfactory Good Very Good

5. How have your relationships with other people been? --None-- Very poor Fair Satisfactory Good Very Good

6. Has your confidence in being able to reduce or stop your alcohol/drug use increased? --None-- Not at all A little Moderately A lot Extremely

8. How satisfied are you with the service provided? --None-- Not at all A little Moderately A lot Extremely