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 Wellness Appraisal
 

Circle the answers below that apply to you. Click here for a printer-friendly version of this self-assessment to bring with you to your first appointment.

 

1. On average, how many days per week do you exercise?

  • None. I do not exercise.
  • 1-2 days.
  • 3-4 days.
  • 5-6 days.
  • Daily.

2. How many times in the past 12 months have you dieted to lose weight?

  • None.
  • 1-2 times.
  • 3-4 times.
  • 5-6 times.
  • 7 or more times.

3. On a typical day, how many cigarettes do you smoke?

  • None. I do not smoke.
  • 1-5
  • 6-10
  • 11-15
  • 16-20
  • 21-30
  • Over 30

4. If you don't smoke now but used to, how long has it been since you quit?

  • Not applicable
  • 3 months or less
  • 4-6 months
  • 7-11 months
  • 1-4 years
  • 5 or more years

5. How often do you drink anything containing alcohol? (If you do not drink, circle "Never" and omit the next two questions).

  • Never.
  • Less than monthly.
  • Weekly.
  • 2-3 times a week.
  • 4-6 times a week.
  • Daily.

 

In the following questions, a "drink" means one beer, one glass of wine, one half of a wine cooler, or a mixed drink containing hard liquor. Each counts as one drink; a mixed drink with double shots counts as two drinks.

 

6. How many drinks do you have on a typical day when you are drinking?

  • 1 drink.
  • 1-2 drinks.
  • 3 drinks.
  • 4 drinks.
  • 5-6 drinks.
  • 7-9 drinks.
  • 10 or more.

7. How often do you have four or more drinks on one occasion?

  • Never.
  • Less than monthly.
  • Monthly.
  • Weekly.
  • 2-3 times a week.
  • 4-6 times a week.
  • Daily.

8. Have you ever used any of the following substances? Circle all that apply.

EcstasyKetamineShroomsInhalantsPCP
MarijuanaLSDCocaineHeroinSpeed
RitalinMeth/crankCrackSteroidsPharmaceuticals

 

9. Have you gambled in the last twelve months? Circle all that apply.

 

Lottery / scratch ticketsSlot machinesCard GamesRacetrack
Sports bettingInternet GamblingCasino bettingDoes not apply

 

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Questions 1 and 2 deal with eating and exercise. There is no "correct" number of how many times one should exercise or diet. To interpret your responses, look for extremes. If you exercise more than 3 - 4 days/week, and it is not required for a sport, are you over exercising? If your exercise gets in the way of your daily studies and your social life, then you probably are exercising too much. If you are dieting to lose weight, especially if you are "always" on a diet, please take a look at the web page on eating disorders. dieting certainly does not mean you have an eating disorder, but you may have symptoms you haven't considered before.

 


Questions 3 and 4 apply to smoking. It is no surprise that cigarette smoking can affect the quality of your life both in the short and long term. Shortness of breath, bronchitis, chronic cough, asthma, agitation, difficulty sleeping and other symptoms may be related to your smoking. Please take a look at our webpage on smoking.


Questions 5, 6 and 7 are more exact in their interpretation. If, in adding the numbers of your responses for those three questions, the total for a woman is less than 7 and less than 8 for a man, that score indicates low risk drinking. We don't call it safe drinking, because there really is no category of safe when it comes to alcohol use. But you can lower your risk for health problems and safety problems when you stay within the low risk category. Although it is legal to purchase and consume at the age of 21, do not forget alcohol is a drug with the potential for addiction and abuse.

If you socre higher than 7 or 8, you are drinking at a high risk level and should consider speaking to someone such as your doctor or counselor who is knowledgeable about alcohol abuse. A score of 16 or above indicates serious problems with alcohol; anyone scoring at that level is at high risk for health and safety problems that often lead to disease and a shorter life span. For more information, please take a look at our web page on alcohol information and our self-test, eChug.

Additionally, drinking, even at low risk levels, can be linked to depression, anxiety disorders and eating disorders. It is a complex relationship, but if you are drinking to mask other symptoms - such as depression - then you are facing additional problems.

Please look at our web pages on depression and anxiety.


Of all the substances listed in question 8, only three are legal drugs in Connecticut - Ritalin, steroids, and pharmaceuticals. What this question is really asking is have you used any of these four illicitly. A "yes" response to any substance in question 8 indicates that you have used or are using an illegal drug. Clearly, any use of an illicit drug is high-risk for health and safety problems both immediately and in the future. For more information, please look at the web pages on drug and alcohol information and other drugs.


Finally, question 9, gambling is not necessarily a high-risk behavior, but it can become a problem when it begins to interfere with your relationships, your finances, your academic life, and/or presents legal problems. For more information, please look at the web pages on gambling.


Wellness is a term used to cover a lot of territory. The appraisal above is just one quick method to take a look at your lifestyle. If you have any questions, or would like to make an appointment with a counselor, please stop by Marcus White 205, or call (860) 832-1945 for an appointment.

 

 

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Self-assessments provided by Central Connecticut State University's Counseling and Wellness Center are for educational purposes only. They are not intended to treat or diagnose a situational or permanent medical condition and are not a replacement for proper medical care. Do not use this information to diagnose or treat a physical or mental health problem without consulting a qualified health or mental care provider. If you find that you are concerned with some of the results, please contact the Counseling and Wellness Center to setup an appointment at (860) 832-1945.
In the case of emergency, always dial 911.

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