Temptation to Use
Drugs 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 tempted you
may be to use illegal drugs in each situation.
circle the number that best describes your feelings
of temptation to use illegal drugs in each situation during the past
week according to the following scale:
1=Not at all tempted
2=Not very tempted
3=Moderately tempted
4=Very tempted
5=Extremely tempted
|
Situation |
Tempted to
use illegal drugs |
||||
|
|
Not
at all |
Not
very |
Moderately |
Very |
Extremely |
|
1) When I am in agony because of stopping
or withdrawing from drug 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 use drugs to
see what happens. |
1 |
2 |
3 |
4 |
5 |
|
8) When I am being offered drugs in a
social situation. |
1 |
2 |
3 |
4 |
5 |
|
9) When I dream about using drugs. |
1 |
2 |
3 |
4 |
5 |
|
10) When I want to test my will power
over using drugs. |
1 |
2 |
3 |
4 |
5 |
|
Situation |
Tempted to use
illegal drugs |
||||
|
|
Not
at all |
Not
very |
Moderately |
Very |
Extremely |
|
11) When I am feeling a physical need or
craving for drugs. |
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 using drugs 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 use drugs with
encourage me to use drugs. |
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 use drugs 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)
Temptation to Use
Drugs 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 tempted you
may be to use illegal drugs in each situation.
circle the number that best describes your feelings
of temptation to use illegal drugs in each situation during the past
week according to the following scale:
1=Not at all tempted
2=Not very tempted
3=Moderately tempted
4=Very tempted
5=Extremely tempted
|
Situation |
Tempted to
use illegal drugs |
||||
|
|
Not
at all |
Not
very |
Moderately |
Very |
Extremely |
|
1) When I am feeling depressed. |
1 |
2 |
3 |
4 |
5 |
|
2) When I am concerned about someone. |
1 |
2 |
3 |
4 |
5 |
|
3) When I am worried. |
1 |
2 |
3 |
4 |
5 |
|
4) When I have the urge to use drugs to
see what happens. |
1 |
2 |
3 |
4 |
5 |
|
5) When I want to test my will power
over using drugs. |
1 |
2 |
3 |
4 |
5 |
|
6) When I am feeling a physical need or
craving for drugs. |
1 |
2 |
3 |
4 |
5 |
|
7) When I am physically tired. |
1 |
2 |
3 |
4 |
5 |
|
8) When I am experiencing some physical
pain or injury. |
1 |
2 |
3 |
4 |
5 |
|
9) When I feel like blowing up because
of frustration. |
1 |
2 |
3 |
4 |
5 |
|
10) When I see others using drugs at a
bar or a party. |
1 |
2 |
3 |
4 |
5 |
|
11) When people I used to use drugs with
encourage me to use drugs. |
1 |
2 |
3 |
4 |
5 |
|
12) When I am excited or celebrating with
others. |
1 |
2 |
3 |
4 |
5 |