Processes of Change Questionnaire

Alcohol Abstinence Self-efficacy Scale Client ID#_________________

Date: ______/______/______

Assessment Point: _____________

Listed below are a number of situations that lead some people to use illegal drugs. We would like to know how Confident you are that you would not Drink Alcohol in each situation.

circle the number that best describes your feelings of confidence to not drink alcohol in each situation during the past week according to the following scale:

1=Not at all confident

2=Not very confident

3=Moderately confident

4=Very confident

5=Extremely confident

Situation	Confident not to drink alcohol
	Not at all	Not very	Moderately	Very	Extremely
1) When I am in agony because of stopping or withdrawing from alcohol use.	1	2	3	4	5
2) When I have a headache.	1	2	3	4	5
3) When I am feeling depressed.	1	2	3	4	5
4) When I am on vacation and want to relax.	1	2	3	4	5
5) When I am concerned about someone.	1	2	3	4	5
6) When I am worried.	1	2	3	4	5
7) When I have the urge to try just one drink to see what happens.	1	2	3	4	5
8) When I am being offered a drink in a social situation.	1	2	3	4	5
9) When I dream about taking a drink.	1	2	3	4	5
10) When I want to test my will power over drinking.	1	2	3	4	5

Situation	Confident not to drink alcohol
	Not at all	Not very	Moderately	Very	Extremely
11) When I am feeling a physical need or craving for alcohol.	1	2	3	4	5
12) When I am physically tired.	1	2	3	4	5
13) When I am experiencing some physical pain or injury.	1	2	3	4	5
14) When I feel like blowing up because of frustration.	1	2	3	4	5
15) When I see others drinking at a bar or a party.	1	2	3	4	5
16) When I sense everything is going wrong for me.	1	2	3	4	5
17) When people I used to drink with encourage me to drink.	1	2	3	4	5
18) When I am feeling angry inside.	1	2	3	4	5
19) When I experience an urge or impulse to take a drink that catches me unprepared.	1	2	3	4	5
20) When I am excited or celebrating with others.	1	2	3	4	5

(12-Item Version)