Pre-Approval Substance and Mental Health Evaluation

- Step 1 of 4

01. Do you sometimes have difficulty controlling how much you use or for how long you use drugs? *

02. Have you made unsuccessful attempts to cut down your drug use? *

03. Do you sometimes spend a significant amount of time using or recovering from your drug use? *

04. Has your drug use had any negative consequences at home, school, or work? (Have you ever lost time off work because of your drug use?) *

05. Has your drug use had any negative consequences to your relationships or social life? (Have you ever concealed how much you use? Has anyone ever commented on your use?) *

06. Have you continued to use despite any negative consequences? *

07. Have you put off things or neglected to do things because of your drug use? (Have you ever disappointed your family or friends? Have you ever missed a family event?) *

08. Do you occasionally have strong cravings for drugs? *

09. Has your tolerance for drugs increased? Are you able to use more than you did before? *

10. Have you experienced withdrawal symptoms the next day after using drugs? (Have you ever been shaky or sweaty that evening or the next day?) *

11. Has your drug use led to any dangerous situations? (Have you ever been charged with impaired driving?) *

Your Score:

2-3 = Mild substance abuse; 4-5 = Moderate substance abuse; 6 or more = Severe substance abuse.
No single test is completely accurate. You should always consult your physician when making decisions about your health.

Reference

American Psychiatric Association, DSM-5 The Diagnostic and Statistical Manual of Mental Disorders. 5 ed, ed. D. Kupfer: American Psychiatric Association.

Change your life so that it’s easier to not use. *

	Never or No = 0	Less than half the time = 1	More than half the time = 3	Always or Yes = 4
How often are you able to set healthy boundaries and say “no” to unreasonable requests?	How often are you able to set healthy boundaries and say “no” to unreasonable requests? Never or No = 0	How often are you able to set healthy boundaries and say “no” to unreasonable requests? Less than half the time = 1	How often are you able to set healthy boundaries and say “no” to unreasonable requests? More than half the time = 3	How often are you able to set healthy boundaries and say “no” to unreasonable requests? Always or Yes = 4
How often are you able to resolve uncomfortable feelings instead of bottling them up?	How often are you able to resolve uncomfortable feelings instead of bottling them up? Never or No = 0	How often are you able to resolve uncomfortable feelings instead of bottling them up? Less than half the time = 1	How often are you able to resolve uncomfortable feelings instead of bottling them up? More than half the time = 3	How often are you able to resolve uncomfortable feelings instead of bottling them up? Always or Yes = 4
How often do you challenge your negative thinking and look for healthier ways of thinking?	How often do you challenge your negative thinking and look for healthier ways of thinking? Never or No = 0	How often do you challenge your negative thinking and look for healthier ways of thinking? Less than half the time = 1	How often do you challenge your negative thinking and look for healthier ways of thinking? More than half the time = 3	How often do you challenge your negative thinking and look for healthier ways of thinking? Always or Yes = 4
How often do you avoid high-risk situations, such as HALT (hungry, angry, lonely, tired) and high-risk people, places, and things?	How often do you avoid high-risk situations, such as HALT (hungry, angry, lonely, tired) and high-risk people, places, and things? Never or No = 0	How often do you avoid high-risk situations, such as HALT (hungry, angry, lonely, tired) and high-risk people, places, and things? Less than half the time = 1	How often do you avoid high-risk situations, such as HALT (hungry, angry, lonely, tired) and high-risk people, places, and things? More than half the time = 3	How often do you avoid high-risk situations, such as HALT (hungry, angry, lonely, tired) and high-risk people, places, and things? Always or Yes = 4
How often do you “play the tape through” when you have cravings?	How often do you “play the tape through” when you have cravings? Never or No = 0	How often do you “play the tape through” when you have cravings? Less than half the time = 1	How often do you “play the tape through” when you have cravings? More than half the time = 3	How often do you “play the tape through” when you have cravings? Always or Yes = 4
How often do you do something to distract yourself when you have cravings?	How often do you do something to distract yourself when you have cravings? Never or No = 0	How often do you do something to distract yourself when you have cravings? Less than half the time = 1	How often do you do something to distract yourself when you have cravings? More than half the time = 3	How often do you do something to distract yourself when you have cravings? Always or Yes = 4

Have you gotten rid of all the people and things that you used to use with? *

Do you have at least 3 strategies for dealing with social settings where drinking or using is involved? *

Ask for help and develop a recovery circle of close family, friends, health professionals, and recovery groups. *

	Never or No = 0	Less than half the time = 1	More than half the time = 3	Always or Yes = 4
In the last month, how many weeks have you gone to a recovery group at least twice?	In the last month, how many weeks have you gone to a recovery group at least twice? Never or No = 0	In the last month, how many weeks have you gone to a recovery group at least twice? Less than half the time = 1	In the last month, how many weeks have you gone to a recovery group at least twice? More than half the time = 3	In the last month, how many weeks have you gone to a recovery group at least twice? Always or Yes = 4
How many days a week do you communicate with a recovery sponsor?	How many days a week do you communicate with a recovery sponsor? Never or No = 0	How many days a week do you communicate with a recovery sponsor? Less than half the time = 1	How many days a week do you communicate with a recovery sponsor? More than half the time = 3	How many days a week do you communicate with a recovery sponsor? Always or Yes = 4
When a situation arises that can affect your recovery, how often do you ask for advice before you take action?	When a situation arises that can affect your recovery, how often do you ask for advice before you take action? Never or No = 0	When a situation arises that can affect your recovery, how often do you ask for advice before you take action? Less than half the time = 1	When a situation arises that can affect your recovery, how often do you ask for advice before you take action? More than half the time = 3	When a situation arises that can affect your recovery, how often do you ask for advice before you take action? Always or Yes = 4
When you have cravings, how often do you reach out and communicate with someone in your recovery circle?	When you have cravings, how often do you reach out and communicate with someone in your recovery circle? Never or No = 0	When you have cravings, how often do you reach out and communicate with someone in your recovery circle? Less than half the time = 1	When you have cravings, how often do you reach out and communicate with someone in your recovery circle? More than half the time = 3	When you have cravings, how often do you reach out and communicate with someone in your recovery circle? Always or Yes = 4
How many weeks in the last month have you done recovery homework, such as, step work?	How many weeks in the last month have you done recovery homework, such as, step work? Never or No = 0	How many weeks in the last month have you done recovery homework, such as, step work? Less than half the time = 1	How many weeks in the last month have you done recovery homework, such as, step work? More than half the time = 3	How many weeks in the last month have you done recovery homework, such as, step work? Always or Yes = 4

Have you made any new recovery friends? *

Be completely honest with yourself and everyone in your recovery circle. *

	Never or No = 0	Less than half the time = 1	More than half the time = 3	Always or Yes = 4
How often are you completely honest and don’t omit any important facts with people in your recovery circle?	How often are you completely honest and don’t omit any important facts with people in your recovery circle? Never or No = 0	How often are you completely honest and don’t omit any important facts with people in your recovery circle? Less than half the time = 1	How often are you completely honest and don’t omit any important facts with people in your recovery circle? More than half the time = 3	How often are you completely honest and don’t omit any important facts with people in your recovery circle? Always or Yes = 4

During the last month, were you ever so honest, when you were sharing, that you felt a little uncomfortable? *

Practice self-care. *

	Never or No = 0	Less than half the time = 1	More than half the time = 3	Always or Yes = 4
How often do you practice healthy eating and sleeping habits?	How often do you practice healthy eating and sleeping habits? Never or No = 0	How often do you practice healthy eating and sleeping habits? Less than half the time = 1	How often do you practice healthy eating and sleeping habits? More than half the time = 3	How often do you practice healthy eating and sleeping habits? Always or Yes = 4
How many days a week do you practice some form of mind-body relaxation?	How many days a week do you practice some form of mind-body relaxation? Never or No = 0	How many days a week do you practice some form of mind-body relaxation? Less than half the time = 1	How many days a week do you practice some form of mind-body relaxation? More than half the time = 3	How many days a week do you practice some form of mind-body relaxation? Always or Yes = 4
How often do you celebrate your small victories?	How often do you celebrate your small victories? Never or No = 0	How often do you celebrate your small victories? Less than half the time = 1	How often do you celebrate your small victories? More than half the time = 3	How often do you celebrate your small victories? Always or Yes = 4
How many weeks in the last month have you had some fun in a clean and sober environment?	How many weeks in the last month have you had some fun in a clean and sober environment? Never or No = 0	How many weeks in the last month have you had some fun in a clean and sober environment? Less than half the time = 1	How many weeks in the last month have you had some fun in a clean and sober environment? More than half the time = 3	How many weeks in the last month have you had some fun in a clean and sober environment? Always or Yes = 4
How many days a week do you write a gratitude list about your recovery, your life, and the people in it?	How many days a week do you write a gratitude list about your recovery, your life, and the people in it? Never or No = 0	How many days a week do you write a gratitude list about your recovery, your life, and the people in it? Less than half the time = 1	How many days a week do you write a gratitude list about your recovery, your life, and the people in it? More than half the time = 3	How many days a week do you write a gratitude list about your recovery, your life, and the people in it? Always or Yes = 4
How often do you feel that you are a good person and that you like yourself?	How often do you feel that you are a good person and that you like yourself? Never or No = 0	How often do you feel that you are a good person and that you like yourself? Less than half the time = 1	How often do you feel that you are a good person and that you like yourself? More than half the time = 3	How often do you feel that you are a good person and that you like yourself? Always or Yes = 4

Don’t bend the rules or try to negotiate your recovery. *

	Never or No = 0	Less than half the time = 1	More than half the time = 3	Always or Yes = 4
How much of the time do you accept that if you start using alcohol or drugs, you won’t always be able to control your use?	How much of the time do you accept that if you start using alcohol or drugs, you won’t always be able to control your use? Never or No = 0	How much of the time do you accept that if you start using alcohol or drugs, you won’t always be able to control your use? Less than half the time = 1	How much of the time do you accept that if you start using alcohol or drugs, you won’t always be able to control your use? More than half the time = 3	How much of the time do you accept that if you start using alcohol or drugs, you won’t always be able to control your use? Always or Yes = 4
How many days a week are you free of “using daydreams”?	How many days a week are you free of “using daydreams”? Never or No = 0	How many days a week are you free of “using daydreams”? Less than half the time = 1	How many days a week are you free of “using daydreams”? More than half the time = 3	How many days a week are you free of “using daydreams”? Always or Yes = 4

Have you completely let go of all secret relapse fantasies, and have you shared the details of those secret plans with someone in your recovery circle? *

Your RAPID Score (0 – 100)

If your score > 70, you are at low risk of currently relapsing. Continue to be mindful of recovery because addiction is cunning and can sneak up on you.
If your score 50 – 70, this is a normal score in early recovery. Don’t be hard on yourself. Recovery is a series of improvements. Everybody who has a successful recovery has had to go through this stage.
If your score < 50, you are at higher risk of relapse. Think about why you want to recover and how you can improve your recovery strategy.

Reference

PDF version of the RAPID test.

Melemis, S. M., Relapse Prevention and the Five Rules of Recovery. Yale J Biol Med, 2015. 88(3): p. 325-32. PMC4553654. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/.

If your mood has been depressed, or you have significantly lost interest or enjoyment for at least 2 weeks, answer the following questions:

01. Low energy. Is your energy lower? Do you feel more fatigued or sluggish? Is it hard to get going in the morning? Do you have less interest in sex? *

02. Anxiety or irritability. Are you more anxious, worried, fearful, irritable, or intolerant? *

03. Lower self-confidence. Is your self-confidence or self-esteem lower? Do you feel more hopeless or pessimistic, or do you feel more guilty or worthless? *

04. Poor concentration. Is it hard for you to think, concentrate, or make decisions? Do you find it hard to concentrate outside of work? Is it harder to read articles or to take in what you read? *

05. Sleep changes. Do you have difficulty falling asleep or staying asleep? On weekends do you feel like you could sleep all day? Do you feel that you're not refreshed when you wake up in the morning? *

06. Appetite or weight change. Is your appetite either significantly lower or higher than a year ago. Have you unintentionally lost or gained weight? Do you eat only because you have to eat, but get little pleasure from food? *

07. Slow moving or restless. Do you move more slowly? Is your speech slower. Are you restless or fidgety? *

08. Thoughts of death. Do you think it would be easier if you just didn't wake up in the morning? Do you think it would be easier if you developed a serious illness? Do you think that your family would be better off if you were gone? Do you have recurrent thoughts of death or suicide (not just a fear of dying)? Do you imagine ways of hurting yourself? *

Your Score:

If you answered yes to four or more questions, you may be suffering from major depressive disorder.
No single test is completely accurate. You should always consult your physician when making decisions about your health.

Reference

American Psychiatric Association, DSM-5 The Diagnostic and Statistical Manual of Mental Disorders. 5 ed, ed. D. Kupfer: American Psychiatric Association.

Over the last 2 weeks, how often have you been bothered by the following problems for at least half the day? *

	Not At All (0)	Several Days (1)	Over Half the Days (2)	Nearly Every Day (3)
01. Feeling nervous, anxious, or on edge	01. Feeling nervous, anxious, or on edge Not At All (0)	01. Feeling nervous, anxious, or on edge Several Days (1)	01. Feeling nervous, anxious, or on edge Over Half the Days (2)	01. Feeling nervous, anxious, or on edge Nearly Every Day (3)
02. Not being able to stop or control worrying	02. Not being able to stop or control worrying Not At All (0)	02. Not being able to stop or control worrying Several Days (1)	02. Not being able to stop or control worrying Over Half the Days (2)	02. Not being able to stop or control worrying Nearly Every Day (3)
03. Worrying too much about different things	03. Worrying too much about different things Not At All (0)	03. Worrying too much about different things Several Days (1)	03. Worrying too much about different things Over Half the Days (2)	03. Worrying too much about different things Nearly Every Day (3)
04. Trouble relaxing	04. Trouble relaxing Not At All (0)	04. Trouble relaxing Several Days (1)	04. Trouble relaxing Over Half the Days (2)	04. Trouble relaxing Nearly Every Day (3)
05. Being so restless that it’s hard to sit still	05. Being so restless that it’s hard to sit still Not At All (0)	05. Being so restless that it’s hard to sit still Several Days (1)	05. Being so restless that it’s hard to sit still Over Half the Days (2)	05. Being so restless that it’s hard to sit still Nearly Every Day (3)
06. Becoming easily annoyed or irritable	06. Becoming easily annoyed or irritable Not At All (0)	06. Becoming easily annoyed or irritable Several Days (1)	06. Becoming easily annoyed or irritable Over Half the Days (2)	06. Becoming easily annoyed or irritable Nearly Every Day (3)
07. Feeling afraid as if something awful might happen	07. Feeling afraid as if something awful might happen Not At All (0)	07. Feeling afraid as if something awful might happen Several Days (1)	07. Feeling afraid as if something awful might happen Over Half the Days (2)	07. Feeling afraid as if something awful might happen Nearly Every Day (3)

Your Score:

If your total score is 10 or more, you may meet the criteria for generalized anxiety disorder.
No test is completely accurate. You should always consult your physician when making decisions about your health.

References

Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B., A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 2006. 166(10): p. 1092-7.
Beidas, R. S., Stewart, R. E., Walsh, L., Lucas, S., et al., Free, brief, and validated: Standardized instruments for low-resource mental health settings. Cogn Behav Pract, 2015. 22(1): p. 5-19. PMC4310476.