Health - Alcohol | QuestionPro

Which case study are you assessing?

Case study 1

Case study 2

What type of Order are you currently on?

ATR

CO/SSO

Licence

On a scale of 1-10 how concerned are you about your alcohol use?

Very concerned

Not concerned

-

How often do you drink alcohol?

Daily/Almost daily

2-4 times a week

Weekly or less

Are there any issues related to alcohol use that may effect your attendance at any appointments?

On average how much alcohol do you drink on each occasion?

1-2

4-9

10+

What are the negative impacts of your alcohol use?

Record description of impacts

Who do you drink alcohol with?

Where do you drink alcohol?

Do you find that when you are intoxicated you are taken advantage of or hurt by other people?

Yes

No

Record details

**PW Flag - Vulnerable Person

**Home Visit may be required

What are the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

:

Phone :

Email Address :

Country :

Criminogenic Need Identified

Substance Misuse

Do you currently drink alcohol?

Yes

No

On a scale of 1-10 how concerned are you about your alcohol use?

Very concerned

Not concerned

-

How often do you drink alcohol?

Daily/Almost daily

2-4 times a week

Weekly or less

Are there any issues related to alcohol use that may effect your attendance at any appointments?

On average how much alcohol do you drink on each occasion?

1-2

4-9

10+

What are the negative impacts of your alcohol use?

Record description of impacts

Do you find that when you are intoxicated you are taken advantage of or hurt by other people?

Yes

No

Record description of impacts:

**PW Flag - Vulnerable Person

**Home Visit may be required

Who do you drink alcohol with?

Where do you drink alcohol?

Are you in treatment now?

Yes

No

Record the details of your current treatment provider?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

:

Phone :

Email Address :

Country :

Criminogenic Need Identified

Substance Misuse

Drinks daily/ almost daily with 4-9 or 10+ units or
Drinks 2-4 times a week with 10 + units
Negative impacts (not including harm to self or others)

Yes

No

Drinks 2-4 times a week with 4-9 units or
Drinks weekly or less with 10+ units +
Negative impacts (not including harm to self or others)

Yes

No

Drinks 2-4 times a week with 4-9 units or
Drinks weekly or less with 10+
And has a negative impact including injured/harm to others

Yes

No

Criminogenic Need Identified

Substance Misuse

Have you ever drunk alcohol?

Yes

No

Have you ever drunk alcohol?

Yes

No

Did you drink alcohol prior to custody?

Yes

No

Did you drink alcohol whilst you were in custody?

Yes

No

Have you ever caused yourself or others problems due to your alcohol use?

Yes

No

What are the negative impacts of your alcohol use?

Description of impacts

When did you last drink alcohol? In months

Did you ever receive treatment in relation to your drinking?

Yes

No

Are you still receiving treatment?

Yes

No

Record details of treatment provider

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

:

Phone :

Email Address :

Country :

Is there anything in addition to your treatment that supports you?

Yes

No

Details of additional support:

On a scale of 1-10 how concerned are you about your alcohol use?

Very concerned

Not concerned

-

How often did you drink alcohol while you were in custody?

Daily/Almost daily

2-4 times a week

Weekly or less

How much on average did you drink on each occasion?

1-2

4-9

10+

Did your drinking ever have a negative impact on you or anyone else?

Record description of impacts

Do you think you will continue drinking alcohol to excess?

Yes

No

Drinks daily/ almost daily with 4-9 or 10+ units or
Drinks 2-4 times a week with 10 + units
Negative impacts (not including harm to self or others)

Yes

No

Drinks 2-4 times a week with 4-9 units or
Drinks weekly or less with 10+ units +
Negative impacts (not including harm to self or others)

Yes

No

Drinks 2-4 times a week with 4-9 units or
Drinks weekly or less with 10+
And has a negative impact including injured/harm to others

Yes

No

Did you drink alcohol whilst you were in custody?

Yes

No

Record details of drinking in custody:

On a scale of 1-10 how concerned are you about your alcohol use?

Very concerned

Not concerned

-

How often do you drink alcohol before custody?

Daily/Almost daily

2-4 times a week

Weekly or less

How much on average did you drink on each occasion?

1-2

4-9

10+

Did your alcohol use ever have a negative impact on you or anyone else?

Units greater than 21 per week?

Yes

No

Record description of impacts

Who do you drink alcohol with?

Where do you drink alcohol?

Do you think you will continue to drink alcohol to excess?

Yes

No

Record why you think that?

Did you find that when you were intoxicated you were taken advantage of or hurt by other people?

Yes

No

Record details

**PW Flag - Vulnerable Person

**Home Visit may be required

Did you have any alcohol treatment in custody?

Yes

No

Record details of detox / treatment

Are you in treatment now?

Yes

No

What are the details of your current treatment?

First Name :

Last Name :

Address 1 :

Address 2 :

City :

Postcode :

:

Phone :

Email Address :

Country :

Drinks daily/ almost daily with 4-9 or 10+ units or
Drinks 2-4 times a week with 10 + units
Negative impacts (not including harm to self or others)

Yes

No

Drinks 2-4 times a week with 4-9 units or
Drinks weekly or less with 10+ units +
Negative impacts (not including harm to self or others)

Yes

No

Drinks 2-4 times a week with 4-9 units or
Drinks weekly or less with 10+
And has a negative impact including injured/harm to others

Yes

No

Criminogenic Need Identified

Substance Misuse

Is Health - Alcohol linked to:

	Yes	No
Risk of re-offending

Risk of serious harm