From the National Library of Medicine (NLM)

Readiness To Change Questionnaire

The following questionnaire is designed to identify how you personally feel about your drinking right now. Please think about your current situation and drinking habits, even if you have given up drinking completely. Read each question below carefully, and then decide to what extent you agree or disagree with the statements

SD-Strongly Disagree  D-Disagree  U-Unsure  A-Agree  SA-Strongly Agree

                                                               SD           D                U                A            SA

 

1. There is no need for me to change my drinking habits. _____ _____ _____ _____ _____   2. I enjoy my drinking, but sometimes I drink too much. _____ _____ _____ _____ _____   3. I have reached the stage where I should seriously think about giving up or drinking less alcohol. _____ _____ _____ _____ _____   4. I am trying to stop drinking or drink less than I used to. _____ _____ _____ _____ _____   5. I was drinking too much at one time, but now I've managed to cut down (or stop) my drinking. _____ _____ _____ _____ _____   6. It's a waste of time thinking about my drinking because I do not have a problem. _____ _____ _____ _____ _____   7. Sometimes I think I should quit or cut down on my drinking. _____ _____ _____ _____ _____   8. I have decided to do something about my drinking. _____ _____ _____ _____ _____   9. I know that my drinking has caused problems, and I'm now trying to correct this. _____ _____ _____ _____ _____   10. I have changed my drinking habits (either cut down or quit), and I'm trying to keep it that way. _____ _____ _____ _____ _____   11. There is nothing seriously wrong with my drinking. _____ _____ _____ _____ _____   12. My drinking is a problem sometimes. _____ _____ _____ _____ _____   13. I'm preparing to change my drinking habits (either cut down or give up completely). _____ _____ _____ _____ _____   14. Anyone can talk about wanting to do something about their drinking, but I am actually doing something about it. _____ _____ _____ _____ _____   15. It is important for me to hold onto the changes I've made, now that I've cut down (or quit) drinking. _____ _____ _____ _____ _____   16. I am a fairly normal drinker. _____ _____ _____ _____ _____   17. I am weighing up the advantages and disadvantages of my present drinking habits. _____ _____ _____ _____ _____   18. I have made a plan to stop or cut down drinking, and I intend to put this plan into practice. _____ _____ _____ _____ _____<span style="FONT-FAMILY: '