Processes of Change Questionnaire Client ID#_________________

Alcohol Version: Form AB Date: ______/______/______

Assessment Point: _____________

EACH STATEMENT BELOW DESCRIBES A SITUATION OR THOUGHT THAT YOU MIGHT USE TO HELP YOU NOT DRINK ALCOHOL DURING THE PAST WEEK.

Instructions:

There are five possible responses to each of the items in the questionnaire:

1=Never

2=Seldom

3=Occasionally

4=Frequently

5=Repeatedly

Please read each statement and circle the number on the right to indicate how often you make use of a particular situation or thought to help you not drink alcohol. Remember these statements refer to situations or thoughts you might use dURING THE PAST WEEK.

	Never	Seldom	Occasionally	Frequently	Repeatedly
1) I do something nice for myself for making efforts to change.	1	2	3	4	5
2) I can talk with at least one special person about my drinking experiences.	1	2	3	4	5
3) I get upset when I think about illnesses caused by drinking.	1	2	3	4	5
4) I see signs in some public places trying to help people not drink.	1	2	3	4	5
5) I stop to think about how my drinking is hurting people around me.	1	2	3	4	5
6) I consider that feeling good about myself includes changing my drinking behavior.	1	2	3	4	5
7) I remove things from my home or work that remind me of drinking.	1	2	3	4	5
8) I calm myself when I get the urge to drink.	1	2	3	4	5
9) I reward myself when I don’t give in to my urge to drink.	1	2	3	4	5

	Never	Seldom	Occasionally	Frequently	Repeatedly
10) I have someone to talk with who understands my problems with alcohol.	1	2	3	4	5
11) Warnings about the health hazards of drinking have an emotional effect on me.	1	2	3	4	5
12) I use will power to stop from drinking.	1	2	3	4	5
13) I notice that people with alcohol problems are making known their desire not to be pressed to drink.	1	2	3	4	5
14) I am considering the idea that people around me would be better off without my problem drinking.	1	2	3	4	5
15) I read newspaper stories that may help me quit drinking.	1	2	3	4	5
16) I avoid situations that encourage me to drink.	1	2	3	4	5
17) I try to think about other things when I begin to think about drinking.	1	2	3	4	5
18) I have someone who listens when I want to talk about my drinking.	1	2	3	4	5
19) Stories about alcohol and its effects upset me.	1	2	3	4	5
20) I make myself aware that I can choose to overcome my drinking if I want to.	1	2	3	4	5
21) I find society changing in ways that make it easier for me to overcome my drinking problem.	1	2	3	4	5
22) I have strong feelings about how much my drinking has hurt the people I care about.	1	2	3	4	5
23) I become disappointed with myself when I depend on alcohol.	1	2	3	4	5
24) I look for information related to problem drinking.	1	2	3	4	5

	Never	Seldom	Occasionally	Frequently	Repeatedly
25) I use reminders to help me not to drink.	1	2	3	4	5
26) I do something else instead of drinking when I need to deal with tension.	1	2	3	4	5
27) I don’t let myself have fun when I drink.	1	2	3	4	5
28) I have someone whom I can count on to help me when I’m having problems with drinking.	1	2	3	4	5
29) I read newspaper stories that can affect me emotionally about my drinking.	1	2	3	4	5
30) I tell myself that if I try hard enough I can keep from drinking.	1	2	3	4	5
31) I stop and think that my drinking is causing problems for other people.	1	2	3	4	5
32) I feel more competent when I decide not to drink.	1	2	3	4	5
33) I seek out groups of people who can increase my awareness about the problems of drinking.	1	2	3	4	5
34) I stay away from places generally associated with my drinking.	1	2	3	4	5
35) I find that doing things is a good substitute for drinking.	1	2	3	4	5
36) I spend time with people who reward me for not drinking.	1	2	3	4	5
37) I make commitments to myself not to drink.	1	2	3	4	5
38) I see advertisements on television about how society is trying to help people not drink.	1	2	3	4	5
39) I think about the type of person I will be if I control my drinking.	1	2	3	4	5
40) I think about information that people have personally given me on the benefits of quitting drinking.	1	2	3	4	5