Page 34 - MELD Stimulant service

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APPENDIX 2

MELD STIMULANT PROJECT: Internal Evaluation
If you have not used anything in the last week please move on to question 1

Frequency
Substance Main
(Including Daily Weekly Monthly Drug free Quantity Route drug? Spend
alcohol)

Q1. If abstinent, have you experienced any cravings in the last
week to use? Please circle

1 2 3 4 5
Low High

Can you please rate the following? Please circle

1 High 2 3 4 5 Low

Anxiety
Stress

Motivation

1 Poor 2 3 4 5 Good
Sleep

Energy
Motivation

Concentration

Have you used any positive coping strategies this week i.e.breath
work, guided meditation or any other? Please also use this box to
make any additional comments.

Signed

Date