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Scenes from the Cancer Prevention Research Center

Alcohol: Self-Efficacy

 

How tempted you may be to drink in each situation?

Enter the number in the box that best describes the feelings of temptation in each situation at the present time according to the following scale:

1 = Not at all tempted
2 = Not very tempted
3 = Moderately tempted
4 = Very tempted
5 = Extremely tempte

 

1.

When I am concerned about someone

box

2.

When I see others drinking at a bar or at a party

box

3.

When I am very worried

box

4.

When I am in agony because of stopping or withdrawing from alcohol use

box

5.

When I have the urge to try just one drink to see what happens

box

6.

When I dream about taking a drink

box

7.

When people I used to drink encourage me to drink

box

8.

When I sense everything is going wrong for me

box

9.

When I am physically tired

box

10.

When I am feeling depressed

box

11.

When I feel like blowing up because of frustration

box

12.

When I experience an urge or impulse to take a drink that catches me unprepared

box

13.

When I am feeling angry inside

box

14.

When I am experiencing some physical pain or injury

box

15.

When I want to test my willpower over drinking

box

16.

When I am being offered a drink in a social situation

box

17.

When I am excited or celebrating with others

box

18.

When I am on vacation and want to relax 

box

19.

When I am feeling a physical need or craving for alcohol

box

20.

When I have a headache

box

 

How confident are you that you would not drink in each situation?

Enter the number in the box that best describes the feeling of confidence in each situation at the present time according to the following:

1 = Not at all confident
2 = Not very confident
3 = Moderately confident
4 = Very confident
5 = Extremely confident

 

1.

When I am in agony because of stopping or withdrawing from alcohol use

box

2.

When I have a headache

box

3.

When I am feeling depressed

box

4.

When I am on vacation and want to relax

box

5.

When I am concerned about someone

box

6.

When I am very worried

box

7.

When I have the urge to try just one drink to see what happens

box

8.

When I am being offered a drink in a social situation

box

9.

When I dream about taking a drink

box

10.

When I want to test my willpower over drinking

box

11.

When I am feeling a physical need or craving for alcohol

box

12.

When I am physically tired

box

13.

When I am experiencing some physical health or injury

box

14.

When I feel like blowing up because of frustration

box

15.

When I see others drinking at a bar or at a party

box

16.

When I sense everything is going wrong for me

box

17.

When people I used to drink with encourage me to drink

box

18.

When I am feeling angry inside

box

19.

When I experience an urge or impulse to take a drink that catches me unprepared

box

 

 

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