This questionnaire is designed to give us a better understanding of what strategies you are using in your treatment. Each statement describes a situation or thought that a person might try to help them not use cocaine. Please indicate how often you might make use of a particular situation or thought to help you at the present time.

 There are FIVE possible responses to each of the items in the questionnaire:

1 = NEVER
2 = SELDOM
3 = OCCASIONALLY
4 = FREQUENTLY
5 = REPEATEDLY

1.	I get upset when I think about my cocaine use.
2.	I stop to think about how my cocaine use is hurting people around me.
3.	I find that keeping myself busy reduces my craving for cocaine.
4.	I avoid people I've used cocaine with.
5.	When I am tempted to use cocaine, I try to distract myself by doing something else.
6.	I have someone who listens when I need to talk about my cocaine use.
7.	I see advertisements and/or news stories on T.V. about how society
8.	I spend time with people who reward me for not using cocaine.
9.	I am ashamed of some of my behaviors while using cocaine.
10.	Someone in my life tries to make me feel good when I do not use cocaine.
11.	I have strong feelings about how much my cocaine use has hurt the people I care about.
12.	I see some signs in public places encouraging people not to use cocaine.
13.	I have heard that cocaine may result in severe mood swings and depression.
14.	I stop and think that my cocaine use is causing problems for other people.
15.	I feel ashamed or disappointed in myself when I depend on cocaine.
16.	I am frightened by some of the situations I have found myself in as a result of my involvement with cocaine.
17.	I find it helpful to do something physically active to keep from using cocaine.
18.	I leave places where people are using cocaine.
19.	I have someone who tries to share their personal experiences of cocaine with me.
20.	Other people in my daily life try to make me feel good when I'm not using cocaine.
21.	Information from the media (magazines, newspaper, radio, T.V.) about cocaine seems to catch my eye.
22.	I make commitments to myself to not turn to cocaine at times when I am feeling anxious or unsure of myself.
23.	I feel frightened by the strength of my cravings for cocaine.
24.	I tell myself that if I try hard enough, I can keep from using cocaine.
25.	Dramatic portrayals of the dangers of cocaine affect me emotionally
26.	I stay away from places generally associated with my cocaine use.
27.	I notice that some people who are quitting cocaine are making known their desire not to be pressed into using.
28.	I have heard about serious medical problems which may result from cocaine use.
29.	I tell myself that I do not need cocaine to make me feel good about myself.
30.	I have someone I can count on when I'm having cocaine related problems.

Scoring

References

Martin, R.A., Rossi, J.S., Rosenbloom, D., Monti, P.M., & Rohsenow, D.J. (1992, November).  Stages and processes of change for quitting cocaine.  Paper presented at the 26th annual meeting of the Association for the Advancement of Behavior Therapy, Boston, MA.

Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L., Redding, C.A., Rosenbloom, D., & Rossi, S.R. (in press). Stages of change and decisional balance for twelve problem behaviors. Health Psychology.

 Rosenbloom, D. (1991). A Transtheoretical Analysis of Change Among Cocaine Users. Unpublished dissertation, University of Rhode Island, Kingston, RI.

 Rossi, J.S. (1992, August). Common processes of change across nine problem behaviors. Paper presented at the 100th annual convention of the American Psychological Association, Washington, DC.