There can be good and bad consequences to any change. These consequences may not be the same for everyone. In thinking about your decision to change your alcohol or drug use, we would like to know what consequences are important to you. This is not a test: There are no right or wrong answers. We simply want to know what you think.
My primary problem drug is (write in name of primary drug, e.g. alcohol, cocaine) ____________________________________________________
All questions below refer to my primary drug use.
When I consider stopping or cutting down my primary drug use, the following reasons are important to me.
THE FOLLOWING STATEMENTS MAY PLAY A PART IN MAKING A DECISION ABOUT USING ALCOHOL (AND DRUGS). WE WOULD LIKE TO KNOW HOW IMPORTANT EACH STATEMENT IS TO YOU AT THE PRESENT TIME IN RELATION TO MAKING A DECISION TO EACH STATEMENT ON THE FOLLOWING 5 POINTS:
1 = Not important at all 2 = Slightly important 3 = Moderately important 4 = Very important 5 = Extremely important
PLEASE READ EACH STATEMENT AND CIRCLE THE NUMBER ON THE RIGHT TO INDICATE HOW YOU RATE ITS LEVEL OF IMPORTANCE AS IT RELATES TO YOUR MAKING A DECISION ABOUT WHETHER TO DRINK (OR USE DRUGS)AT THE PRESENT TIME.
How important is this to me?
Importance in making a decision about drinking:
Not At All
Slightly
Moderately
Very
Extremely
1.
My drinking (drug use) causes problems with others.
1
2
3
4
5
2.
I like myself better when I am drinking (using drugs).
1
2
3
4
5
3.
Because I continue to drink (use drugs) some people think I lack the character to quit.
1
2
3
4
5
4.
Drinking (drug use) helps me deal with problems.
1
2
3
4
5
5.
Having to lie to others about my drinking (drug use) bothers me.
1
2
3
4
5
6.
Some people try to avoid me when I drink (use drugs).
1
2
3
4
5
7.
Drinking (drug use) helps me to have fun and socialize.
1
2
3
4
5
8.
Drinking (drug use) interferes with my functioning at home or/and at work.
1
2
3
4
5
9.
Drinking (drug use) makes me more of a fun person.
1
2
3
4
5
10.
Some people close to me are disappointed in me because of my drinking (drug use).
1
2
3
4
5
11.
Drinking (drug use) helps me to loosen up and express myself.
1
2
3
4
5
12.
I seem to get myself into trouble when drinking (using drugs).
1
2
3
4
5
13.
I could accidentally hurt someone because of my drinking (drug use).
1
2
3
4
5
14.
Not drinking (using drugs) at a social gathering would make me feel too different.
1
2
3
4
5
15.
I am losing the trust and respect of my coworkers and/or spouse because of my drinking (drug use).
1
2
3
4
5
16.
My drinking (drug use) helps give me energy and keeps me going.
1
2
3
4
5
17.
I am more sure of myself when I am drinking (using drugs).
1
2
3
4
5
18.
I am setting a bad example for others with my drinking (drug use).
1
2
3
4
5
19.
Without alcohol (illegal drugs), my life would be dull and boring.
1
2
3
4
5
20.
People seem to like me better when I am drinking (using drugs).
1
2
3
4
5
Scoring:
Pros of drinking (drug use) are items: 2, 4, 7, 9, 11, 14, 16, 17, 19, 20.
Cons of drinking (drug use) are items: 1, 3, 5, 6, 8, 10, 12, 13, 15, 18.
To get the average number of pros endorsed, add up the total number of points from the items and divide by 10. Example: Pros of drinking (drug use) = Sum of items (2+4+7+9+11+14+16+17+19+20) divided by 10.
To get the average number of cons endorsed, add up the total number of points from the items and divide by 10. Example: Cons of drinking (drug use) = Sum of items (1+3+5+6+8+10+12+13+15+18) divided by 10.
This questionnaire consists of a series of statements that describe possible effects following alcohol use. We would like to find out about your present beliefs about alcohol.
Please read each of the statements and respond according to your experiences with a heavy (5 drinks or more per occasion) amount of alcohol. If you believe alcohol sometimes or always has the stated effect on you, check AGREE. If you believe alcohol never has the stated effect on you, check DISAGREE.
Then, in the column to the far right, fill in the number that best corresponds to the strength of your belief, according to the following scale:
1 = Mildly Believe
10 = Strongly Believe
For example, if you strongly believe that alcohol makes you more intelligent, you would check AGREE and enter a "10" in thefar column.
Please answer every questionwithout skipping any.
For a HEAVY (5 or more drinks per occasion) amount of alcohol
Agree
Disagree
Strength of Belief
1.
Drinking makes me feel flushed.
____
____
____
2.
Alcohol decreases muscular tension in my body.
____
____
____
3.
Drinking makes me feel less shy.
____
____
____
4.
Alcohol enables me to fall asleep much more easily.
____
____
____
5.
I feel powerful when I drink, as if I can really influence others to do what I want.
____
____
____
6.
I'm more clumsy after I drink.
____
____
____
7.
I'm more romantic when I drink.
____
____
____
8.
Drinking makes the future seem brighter to me.
____
____
____
9.
If I have had alcohol it is easier for me to tell someone off.
____
____
____
10.
I can't act as quickly when I've been drinking.
____
____
____
11.
Alcohol can act as an anesthetic for me; that is, it can deaden the pain.
____
____
____
12.
I often feel sexier after I've been drinking.
____
____
____
13.
Drinking makes me feel good.
____
____
____
14.
Alcohol makes me careless about my actions.
____
____
____
15.
Alcohol has a pleasant, cleansing, tingly taste to me.
____
____
____
16.
Drinking increases my aggressiveness.
____
____
____
17.
Alcohol seems like magic to me.
____
____
____
18.
Alcohol makes it hard for me to concentrate.
____
____
____
19.
After drinking, I'm a better lover.
____
____
____
20.
When I'm drinking, it is easier to open up and express my feelings.
____
____
____
21.
Drinking adds a certain warmth to social occasions for me.
____
____
____
22.
If I'm feeling restricted in any way, drinking makes me feel better.
____
____
____
23.
I can't think as quickly after I drink.
____
____
____
24.
Having drinks is a nice way for me to celebrate special occasions.
____
____
____
25.
Alcohol makes me worry less.
____
____
____
26.
Drinking makes me inefficient.
____
____
____
27.
Drinking is pleasurable because it's enjoyable for me to join in with other people who are enjoying themselves.
____
____
____
28.
After drinking, I am more sexually responsive.
____
____
____
29.
I feel more coordinated after I drink.
____
____
____
30.
I'm more likely to say embarrassing things after drinking.
____
____
____
31.
I enjoy having sex more if I've had alcohol.
____
____
____
32.
I'm more likely to get into an argument if I've had alcohol.
____
____
____
33.
Alcohol makes me less concerned about doing things well.
____
____
____
34.
Alcohol helps me sleep better.
____
____
____
35.
Drinking gives me more confidence in myself.
____
____
____
36.
Alcohol makes me more irresponsible.
____
____
____
37.
After drinking it is easier for me to pick a fight.
____
____
____
38.
Alcohol makes it easier for me to talk to people.
____
____
____
39.
If I have alcohol it is easier for me to express my feelings.
The following pages contain statements about the effects of alcohol. Read each statement carefully and respond according to your own personal thoughts, feelings, and beliefs about alcohol now. We are interested in what you think about alcohol, regardless of what other people might think.
If you think that the statement is true, or mostly true, or true some of the time, then mark (X) "Agree" on the answer sheet. If you think the statement is false, or mostly false, then mark (X) "Disagree" on the answer sheet. When the statements refer to drinking alcohol you may think in terms of drinking any alcoholic beverage, such as beer, wine, whiskey, liquor, rum, scotch, vodka, gin, or various alcoholic mixed drinks. Whether or not you have had actual drinking experiences yourself, you are to answer in terms of your beliefs about alcohol. It is important that you respond to every question.
PLEASE BE HONEST. REMEMBER, YOUR ANSWERS ARE CONFIDENTIAL.
RESPOND TO THESE ITEMS ACCORDING TO WHAT YOU PERSONALLY BELIEVE TO BE TRUE ABOUT ALCOHOL
(Mark "X" according to your beliefs)
Agree
Disagree
1.
Alcohol can transform my personality.
______
______
2.
Drinking helps me feel whatever way I want to feel.
______
______
3.
Some alcohol has a pleasant, cleansing, tingly taste.
______
______
4.
Alcohol makes me feel happy.
______
______
5.
Drinking adds a certain warmth to social occasions.
______
______
6.
Sweet mixed drinks taste good.
______
______
7.
When I am drinking, it is easier to open up and express my feelings.
______
______
8.
Time passes quickly when I am drinking.
______
______
9.
When they drink, women become more sexually relaxed.
______
______
10.
Drinking makes me feel flushed.
______
______
11.
I feel powerful when I drink, as if I can really influence others to do
as I want.
______
______
12.
Drinking increases male aggressiveness.
______
______
13.
Alcohol lets my fantasies flow more easily.
______
______
14.
Drinking gives me more confidence in myself.
______
______
15.
Drinking makes me feel good.
______
______
16.
I feel more creative after I have been drinking.
______
______
17.
Having a few drinks is a nice way to celebrate special occasions.
______
______
18.
I can discuss or argue a point more forcefully after I have had
a few drinks.
______
______
19.
When I am drinking, I feel free to be myself and to do whatever I want.
______
______
20.
Drinking makes it easier to concentrate on the good feelings I have
at the time.
______
______
21.
Alcohol allows me to be more assertive.
______
______
22.
When I feel "high" from drinking, everything seems to feel better.
______
______
23.
A drink or two makes the humorous side of me come out.
______
______
24.
If I am nervous about having sex, alcohol makes me feel better.
______
______
25.
Drinking relieves boredom.
______
______
26.
I find that conversing with members of the opposite sex is easier for me after I have had a few drinks.
______
______
27.
After a few drinks, I feel less sexually inhibited.
______
______
28.
Drinking is pleasurable because it is enjoyable to join in with people who are enjoying themselves.
______
______
29.
I like the taste of some alcoholic beverages.
______
______
30.
If I am feeling restricted in any way, a few drinks make me feel better.
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