Sample Congregational Survey (Adapted from Healing Places: How Faith Institutions Can Effectively Address Chemical Dependency, by Johnny Allem and Trish Merrill, The Johnson Institute, 2004, p. 135. Used with permission.) Introduction of Survey to Congregation “Several members of this congregation are exploring the possibility of beginning a special ministry for people who suffer the physical, spiritual, and emotional devastation of addictive behaviors—their own and those of others. This ministry would also work to prevent the use and abuse of alcohol and drugs among young people. Your answers to the questions below will help us determine if there’s a place for this ministry within our church and will be held in confidence. Any reports from this survey will not identify individual responses. If you have any questions or want to join our group, call (contact name) at (phone number) or give us your name and phone number. Thank you for your help.” - How confident do you feel about helping young people make good decisions about alcohol, tobacco and other drugs?
_ Very _ Somewhat _ Not at all - Would you be interested in learning more about ...? (Check all that apply)
_ Addictions _ Recovery _ Prevention _ None - Would you support our congregation reaching out to people who suffer from addiction?
_ Yes _ No _ Not sure - Do you have a family member with an alcohol or drug problem?
_ No _ Yes, alcohol _ Yes, drug A full survey exploring support for educational programs, early intervention training, and information about member incidence of addiction and recovery as well as soliciting help with the team ministry or special projects and implementation instructions may be obtained from the Rush Center of the Johnson Institute at 512-451-9504 or toll free 1-888-451-9527. | 
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