University of Rhode
Island Client
ID#_________________
Change Assessment
Scale (URICA) : Date:
______/______/______
Drug Version Assessment Point: _____________
EACH
STATEMENT BELOW DESCRIBES A HOW A PERSON MIGHT FEEL WHEN STARTING THERAPY OR
APPROACHING Problems IN THEIR LIVES.
Please indicate the extent to which YOU TEND to agree or disagree with
each statement. In each case, make your
choice in terms of how you feel riGHt now, not what you have felt in the
past or would like to feel. For all
statements that refer to your “problem”, answer in terms of problems related to
your illegal drug use. The
words “here” and “this place” refer to your treatment center.
There
are five possible responses to each of the items in the questionnaire:
1=Strongly Disagree
2=Disagree
3=Undecided
4=Agree
5=Strongly Agree
Circle the number that best describes how much you
agree or disagree with each statement.
|
|
Strongly
Disagree |
Disagree |
Undecided |
Agree |
Strongly
Agree |
|
1) As far as I’m concerned, I don’t have
any problems that need changing. |
1 |
2 |
3 |
4 |
5 |
|
2) I think I might be ready for some
self-improvement. |
1 |
2 |
3 |
4 |
5 |
|
3) I am doing something about the
problems that had been bothering me. |
1 |
2 |
3 |
4 |
5 |
|
4) It might be worthwhile to work on my
problem. |
1 |
2 |
3 |
4 |
5 |
|
5) I’m not the problem one. It doesn’t
make much sense for me to consider changing. |
1 |
2 |
3 |
4 |
5 |
|
6) It worries me that I might slip back
on a problem I have already changed, so I am looking for help. |
1 |
2 |
3 |
4 |
5 |
|
7) I am finally doing some work on my problem. |
1 |
2 |
3 |
4 |
5 |
|
8) I’ve been thinking that I might want
to change something about myself. |
1 |
2 |
3 |
4 |
5 |
|
9) I have been successful in working on
my problem but I’m not sure I can keep up the effort on my own. |
1 |
2 |
3 |
4 |
5 |
|
|
Strongly
Disagree |
Disagree |
Undecided |
Agree |
Strongly
Agree |
|
|
10) At times my problem is difficult, but
I’m working on it. |
1 |
2 |
3 |
4 |
5 |
|
|
11) Trying to change is pretty much a
waste of time for me because the problem doesn’t have to do with me. |
1 |
2 |
3 |
4 |
5 |
|
|
12) I’m hoping that I will be able to
understand myself better. |
1 |
2 |
3 |
4 |
5 |
|
|
13) I guess I have faults, but there’s
nothing that I really need to change. |
1 |
2 |
3 |
4 |
5 |
|
|
14) I am really working hard to change. |
1 |
2 |
3 |
4 |
5 |
|
|
15) I have a problem and I really think I
should work on it. |
1 |
2 |
3 |
4 |
5 |
|
|
16) I’m not following though with what I
had already changed as well as I had hoped, and I want to prevent a relapse
of the problem. |
1 |
2 |
3 |
4 |
5 |
|
|
17) Even though I’m not always successful
in changing, I am at least working on my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
18) I thought once I had resolved the
problem I would be free of it, but sometimes I still find myself struggling
with it. |
1 |
2 |
3 |
4 |
5 |
|
|
19) I wish I had more ideas on how to
solve my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
20) I have started working on my problem
but I would like help. |
1 |
2 |
3 |
4 |
5 |
|
|
21) Maybe someone or something will be
able to help me. |
1 |
2 |
3 |
4 |
5 |
|
|
22) I may need a boost right now to help
me maintain the changes I’ve already made. |
1 |
2 |
3 |
4 |
5 |
|
|
23) I may be part of the problem, but I
don’t really think I am. |
1 |
2 |
3 |
4 |
5 |
|
|
24) I hope that someone will have some
good advice for me. |
1 |
2 |
3 |
4 |
5 |
|
|
|
Strongly
Disagree |
Disagree |
Undecided |
Agree |
Strongly
Agree |
|
|
25) Anyone can talk about changing; I’m
actually doing something about it. |
1 |
2 |
3 |
4 |
5 |
|
|
26) All this talk about psychology is
boring. Why can’t people just forget
about their problems? |
1 |
2 |
3 |
4 |
5 |
|
|
27) I’m struggling to prevent myself from
having a relapse of my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
28) It is frustrating, but I feel I might
be having a recurrence of a problem I thought I had resolved. |
1 |
2 |
3 |
4 |
5 |
|
|
29) I have worries but so does the next
guy. Why spend time thinking about them? |
1 |
2 |
3 |
4 |
5 |
|
|
30) I am actively working on my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
31) I would rather cope with my faults
than try to change them. |
1 |
2 |
3 |
4 |
5 |
|
|
32) After all I had done to try and
change my problem, every now and then it comes back to haunt me. |
1 |
2 |
3 |
4 |
5 |
|
(24-Item Version)
University of Rhode
Island Client
ID#_________________
Change Assessment
Scale (URICA) : Date:
______/______/______
Drug Version Assessment Point: _____________
EACH
STATEMENT BELOW DESCRIBES A HOW A PERSON MIGHT FEEL WHEN STARTING THERAPY OR
APPROACHING Problems IN THEIR LIVES.
Please indicate the extent to which YOU TEND to agree or disagree with
each statement. In each case, make your
choice in terms of how you feel riGHt now, not what you have felt in the
past or would like to feel. For all
statements that refer to your “problem”, answer in terms of problems related to
your illegal drug use. The
words “here” and “this place” refer to your treatment center.
There
are five possible responses to each of the items in the questionnaire:
1=Strongly Disagree
2=Disagree
3=Undecided
4=Agree
5=Strongly Agree
Circle the number that best describes how much you
agree or disagree with each statement.
|
|
Strongly
Disagree |
Disagree |
Undecided |
Agree |
Strongly
Agree |
|
|
1) I’m not the problem one. It doesn’t
make much sense for me to consider changing. |
1 |
2 |
3 |
4 |
5 |
|
|
2) I am finally doing some work on my
problem. |
1 |
2 |
3 |
4 |
5 |
|
|
3) I’ve been thinking that I might want
to change something about myself. |
1 |
2 |
3 |
4 |
5 |
|
|
4) At times my problem is difficult, but
I’m working on it. |
1 |
2 |
3 |
4 |
5 |
|
|
5) Trying to change is pretty much a
waste of time for me because the problem doesn’t have to do with me. |
1 |
2 |
3 |
4 |
5 |
|
|
6) I’m hoping that I will be able to
understand myself better. |
1 |
2 |
3 |
4 |
5 |
|
|
7) I guess I have faults, but there’s
nothing that I really need to change. |
1 |
2 |
3 |
4 |
5 |
|
|
8) I am really working hard to change. |
1 |
2 |
3 |
4 |
5 |
|
|
9) I have a problem and I really think I
should work on it. |
1 |
2 |
3 |
4 |
5 |
|
|
10) I’m not following though with what I
had already changed as well as I had hoped, and I want to prevent a relapse
of the problem. |
1 |
2 |
3 |
4 |
5 |
|
|
|
Strongly
Disagree |
Disagree |
Undecided |
Agree |
Strongly
Agree |
|
|
11) Even though I’m not always successful
in changing, I am at least working on my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
12) I thought once I had resolved the
problem I would be free of it, but sometimes I still find myself struggling
with it. |
1 |
2 |
3 |
4 |
5 |
|
|
13) I wish I had more ideas on how to
solve my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
14) Maybe someone or something will be
able to help me. |
1 |
2 |
3 |
4 |
5 |
|
|
15) I may need a boost right now to help
me maintain the changes I’ve already made. |
1 |
2 |
3 |
4 |
5 |
|
|
16) I may be part of the problem, but I
don’t really think I am. |
1 |
2 |
3 |
4 |
5 |
|
|
17) I hope that someone will have some
good advice for me. |
1 |
2 |
3 |
4 |
5 |
|
|
18) Anyone can talk about changing; I’m
actually doing something about it. |
1 |
2 |
3 |
4 |
5 |
|
|
19) All this talk about psychology is
boring. Why can’t people just forget
about their problems? |
1 |
2 |
3 |
4 |
5 |
|
|
20) I’m struggling to prevent myself from
having a relapse of my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
21) It is frustrating, but I feel I might
be having a recurrence of a problem I thought I had resolved. |
1 |
2 |
3 |
4 |
5 |
|
|
22) I have worries but so does the next
guy. Why spend time thinking about them? |
1 |
2 |
3 |
4 |
5 |
|
|
23) I am actively working on my problem. |
1 |
2 |
3 |
4 |
5 |
|
|
24) After all I had done to try and
change my problem, every now and then it comes back to haunt me. |
1 |
2 |
3 |
4 |
5 |
|