Christo Inventory | Addictions UK

Christo Inventory for Substance-misuse Services

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Your contact details

First Name
Last Name
Date of Birth
House Number or Name
Street
Town, City etc.
County
Postcode, Zip, etc.
Telephone
Fax
Mobile
Email
Reference
Confirmation Code
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Below you will see a list of common symptoms of anxiety. Please indicate how much you were bothered by each.

Please answer every question indicating:
Bothered: 0="Not at all", 1="A little", 2="A lot", 3="Almost unbearably"

1. Social Functioning

I have a stable place to live and supportive friends or relatives who are drug/alcohol free.
My living situation is not completely stable; I sometimes associate with drug users or heavy drinkers
My living situation is not stable. I have few friends other than drug users or heavy drinkers.

2. General Health

I have no significant health problems.
I have moderate health problems e.g., teeth/sleep problems, occasional stomach pain, collapsed vein, asymptomatic hep B/C/HIV.
I have major health problems e.g. extreme weight loss, jaundice, abscesses/infections, coughing up blood, fever, overdoses, blackouts, seizures, significant memory loss, neurological damage, HIV symptoms.

3. Sexual/injecting risk behaviour

I do not to inject, or have unsafe sex (except in monogamous relationship with longstanding partner, spouse).
I occasionally have 'unsafe' sexual encounters or inject but I don't share injecting equipment.
I sometimes have 'unsafe' sexual encounters or have been injecting and sharing injecting equipment.

4. Psychological

I think I am well adjusted and relatively satisfied with the way my life is going.
I think I may have low self-esteem, general anxiety, poor sleep, and am unhappy or dissatisfied with my lot.
I have a neurotic disorder e.g., panic attacks, phobias, OCD, bulimia, recently attempted or I have seriously considered suicide, self-harm, overdose or may be clinically depressed. Or I may have psychotic disorders, paranoia (e.g., everybody is plotting against me), deluded beliefs or hallucinations (e.g. hearing voices).

5. Occupation

I am in a full time occupation e.g., homemaker, parent, employed, or student.
I have some part time parenting, occupation or voluntary work.
I am largely unoccupied with any socially acceptable passime.

6. Criminal involvement

I have no criminal involvement (apart from possible possession of illicit drugs for personal use).
I have been suspected of irregular criminal involvement, like petty fraud, petty theft, drunk driving, small scale dealing.
I have been suspected of regular criminal involvement, or breaking and entering, car theft, robbery, violence, assault.

7. Drug/alcohol use

I have not recently used drugs or alcohol.
I sometimes use drugs or alcohol alone or socially but not in ways that are considered a problem. I do not supplement prescribed from other sources.
I am a binge drinker or regularly use drugs or alcohol.

8. Ongoing support

I regularly attend AA/NA, a drug-free drop in centre, day centre, or have counselling or treatment aftercare.
I sometimes (less than once a week) have contact with at least one of AA/NA, a drug-free drop in centre, day centre, or have counselling or treatment aftercare.
I don't use any type of structured support.

9. Compliance

I am good at attending all appointments and meetings on time, following suggestions, and complying with treatment requirements.
Some people think I am not very reliable, or may have an 'attitude problem' or other difficulties with staff.
I'm pretty chaotic. I have left treatment against staff advice or been ejected for non-compliance e.g. drug use, attitude problem.

10. Working Relationship

I'm relatively easy going, relaxed at interviews and don't waste peoples' time or stress them out.
Some people seem to think I am a little bit demanding or time consuming.
People find me challenging e.g., very demanding, hard work, time consuming, emotionally draining or stressful to see.