Name: ________________________________________ Date : ______________
Rate how satisfied you are with the following areas of your life by placing a check- mark in the appropriate boxes.
| Subject | Very Dissatisfied | Somewhat Dissatisfied | Neutral | Somewhat Satisfied | Very Satisfied |
| Career | |||||
| Friends | |||||
| Family | |||||
| Romantic Relationships | |||||
| Drug Use/Cravings | |||||
| Alcohol Use/Cravings | |||||
| Self-Esteem | |||||
| Physical Health | |||||
| Psychological Well-Being | |||||
| Sexual Fulfillment | |||||
| Spiritual Well-Being |
Which of these areas have improved the most since you entered treatment?
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Which are your weakest areas? How are you planning to improve them?
____________________________________________________
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What would need to change for you to be satisfied with the areas you rated lowest?
____________________________________________________
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