GAIN Screener

Thank you for connecting with Addiction Services and for completing the initial intake form. This short screener is the second step of our intake package and must be completed within 24hr. Once completed an intake counsellor will call you within 2 business days to complete the process and get you connected with services.

 
 
 
 
 
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The following questions are about common psychological, behavioural, and personal problems. These problems are considered significant when you have them for two or more weeks, when they keep coming back, when they keep you from meeting your responsibilities, or when they make you feel like you can’t go on. After each of the following questions, please tell us the last time, if ever, you had the problem by answering whether it was in the past month, 2 to 3 months ago, 4 to 12 months ago, 1 or more years ago, or never. 4 = Past month 3 = 2 to 3 months ago 2 = 4 to 12 months ago 1 = 1+ years ago 0 = Never

 

feeling very trapped, lonely, sad, blue, depressed or hopeless about the future?

 

sleep trouble, such as bad dreams, sleeping restlessly, or falling asleep during the day?

 

feeling very anxious, nervous, tense, scared, panicked, or like something bad was going to happen?

 

becoming very distressed and upset when something reminded you of the past?

 

thinking about ending your life or committing suicide?

 

seeing or hearing things that no one else could see or hear or feeling that someone else could read or control your thoughts?

 

Reminder:

After each of the following questions, please tell us the last time, if ever, you had the problem by answering whether it was in the past month, 2 to 3 months ago, 4 to 12 months ago, 1 or more years ago, or never. 4 = Past month 3 = 2 to 3 months ago 2 = 4 to 12 months ago 1 = 1+ years ago 0 = Never

 

Lied or conned to get things you wanted or to avoid having to do something.

 

Had a hard time paying attention at school, work, or home.

 

Had a hard time listening to instructions at school, work or home.

 

Had a hard time waiting for your turn.

 

Were a bully or threatened other people.

 

Started physical fights with other people.

 

Tried to win back your gambling losses by going back another day.

 

Reminder:

After each of the following questions, please tell us the last time, if ever, you had the problem by answering whether it was in the past month, 2 to 3 months ago, 4 to 12 months ago, 1 or more years ago, or never. 4 = Past month 3 = 2 to 3 months ago 2 = 4 to 12 months ago 1 = 1+ years ago 0 = Never

 

you used alcohol or other drugs weekly or more often?

 

you spent a lot of time either getting alcohol or other drugs, using alcohol or other drugs, or recovering from the effects of alcohol or other drugs (e.g., feeling sick)?

 

you kept using alcohol or other drugs even though it was causing social problems, leading to fights, or getting you into trouble with other people?

 

your use of alcohol or other drugs caused you to give up or reduce your involvement in activities at work, school, home, or social events?

 

you had withdrawal problems from alcohol or other drugs like shaky hands, throwing up, having trouble sitting still or sleeping, or you used any alcohol or other drugs to stop being sick or avoid withdrawal problems?

 

had a disagreement in which you pushed, grabbed, or shoved someone?

 

took something from a store without paying for it?

 

sold, distributed, or helped to make illegal drugs?

 

drove a vehicle which under the influence of alcohol or illegal drugs?

 

purposely damaged or destroyed property that did not belong to you?

 

Reminder:

After each of the following questions, please tell us the last time, if ever, you had the problem by answering whether it was in the past month, 2 to 3 months ago, 4 to 12 months ago, 1 or more years ago, or never. 4 = Past month 3 = 2 to 3 months ago 2 = 4 to 12 months ago 1 = 1+ years ago 0 = Never

 

missing meals or throwing up much of what you did eat to control your weight?

 

eating binges or times when you ate a very large amount of food within a short period of time and then felt guilty?

 

being disturbed by memories or dreams of distressing things from the past that you did, saw, or had happen to you?

 

thinking or feeling that people are watching you, following you, or out to get you?

 

videogame playing or internet use that caused you to give up, reduce, or have problems with important activities or people at work, school, home or social events?

 

gambling that caused you to give up, reduce, or have problems with important activities or people at work, school, home, or social events?

 
 

Thank you for completing this screener.

Once you hit submit the form you will automatically be directed to our Client Orientation Handbook, located on our website. We also welcome you to visit virtual Supportive Information Sessions page. There you will find access to online versions of a selection of Supportive Information Sessions. These sessions are helpful if you’re looking for additional support in between or in advance of sessions or groups with our clinicians.