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
1.
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There is no need for me to change my drinking habits.
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_____
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2.
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I enjoy my drinking, but sometimes I drink too much.
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_____
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_____
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_____
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_____
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3.
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I have reached the stage where I should seriously think about giving up or drinking less alcohol.
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_____
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4.
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I am trying to stop drinking or drink less than I used to.
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_____
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_____
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_____
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_____
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5.
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I was drinking too much at one time, but now I've managed to cut down (or stop) my drinking.
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_____
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_____
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6.
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It's a waste of time thinking about my drinking because I do not have a problem.
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7.
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Sometimes I think I should quit or cut down on my drinking.
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8.
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I have decided to do something about my drinking.
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9.
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I know that my drinking has caused problems, and I'm now trying to correct this.
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10.
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I have changed my drinking habits (either cut down or quit), and I'm trying to keep it that way.
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_____
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11.
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There is nothing seriously wrong with my drinking.
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12.
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My drinking is a problem sometimes.
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13.
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I'm preparing to change my drinking habits (either cut down or give up completely).
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14.
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Anyone can talk about wanting to do something about their drinking, but I am actually doing something about it.
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_____
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_____
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15.
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It is important for me to hold onto the changes I've made, now that I've cut down (or quit) drinking.
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_____
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_____
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16.
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I am a fairly normal drinker.
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17.
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I am weighing up the advantages and disadvantages of my present drinking habits.
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18.
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I have made a plan to stop or cut down drinking, and I intend to put this plan into practice.
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_____
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I work in a treatment agency and am interested in using this questionnaire in a treatment group. How do I go about receiving permission for such?
607-762-3292
Hi Andrea,
I know this is really late, but just incase no one else has replied to your request, go to the following link:
http://afcrossroads.com/websites/corc_docs/SG_Toolkit/Bucket3/Readiness_to_Change_Questionnaire_Info.pdf
There you will find details of the copyright status of the RTCQ and who to contact ( I think its Nick Heather) for permission. Although, as there is no charge for using it, I expect you would only need to cite the author when you use it.
Good luck
Jay
Thanks, Jay - I appreciate your response.