WELLNESS (continued) Addictions Past History of Addictions:  No  Yes  Denies  Unknown Addiction Issues: Alcohol Drugs Exercise Food     Gambling Sexual Tobacco Other ___________     (specify) Other Addiction Issues: Addiction Comments: What Activities Do You Associate with Your Addiction? What Activities Did You Have to Give Up Due to Your Addiction? What Leisure Activities Have You Learned to Do Without the Use of a Substance? COMMUNITY SKILLS Community Living Skills / Self-Care Skills Community Resources Utilized Community Center Health Clubs Library Malls     Mental Movie Theaters Parks and Recreation Restaurants     Support Groups Other    ______________ (specify) Community Resources Comments: Community Living Needs:  Clothing care / Selection  Grooming / Hygiene  Home maintenance / Cleaning  Money management  Nutritional / Meal planning  Resource utilization  Shopping  Survival skills Safety  Transportation  Other Time management  ________________________  (specify) Community Living Comments: 7
WELLNESS (continued) Addictions Past History of Addictions:  No  Yes  Denies  Unknown Addiction Issues:  Alcohol  Gambling  Drugs  Sexual  Exercise  Tobacco  Food  Other (specify) ___________ Other Addiction Issues: Addiction Comments: What Activities Do You Associate with Your Addiction? What Activities Did You Have to Give Up Due to Your Addiction? What Leisure Activities Have You Learned to Do Without the Use of a Substance? COMMUNITY SKILLS Community Living Skills / Self-Care Skills Community Resources Utilized  Community Center  Mental   Health Clubs  Movie Theaters  Support Groups  Library  Parks and Recreation  Other (specify) ______________  Malls  Restaurants Community Resources Comments: Community Living Needs:  Clothing care / Selection  Money management  Safety  Time management  Grooming / Hygiene  Nutritional / Meal planning  Shopping  Transportation  Home maintenance / Cleaning  Resource utilization  Survival skills  Other (specify) ________________________ Community Living Comments: 7
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