ILC Questionnaire #2 Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Email address *To get a confirmation for completion of the surveyListed below are situations in which some people experience a strong urge to use alcohol or drugs. Think about your PRIMARY drug/alcohol problem and how strong you are to resist the urge to use right now. What is the PRIMARY drug you are thinking about as you fill this out? *All drugs and alcoholNone, I don't use any of theseOpiates, heroin, fentanyl, pain pillsAlcoholMarijuana, CannabisMethamphetamineAny other drugs (acid, Xanax, cocaine, etc.)Check off the one you are trying to resist.How confident are you that you will be ABLE to RESIST the URGE to use your primary drug? SLIDE THE BUTTON to a number. 0% means "I WILL USE." 100% means "I WILL NOT USE." 1. UNPLEASANT EMOTIONS Selected Value: 0 (e.g. If I were depressed about things in general: if everything was going badly for me.) 2. PHYSICAL DISCOMFORT Selected Value: 0 (e.g. If I would have trouble sleeping; If I felt jumpy and physically tense).3. PLEASANT EMOTIONS Selected Value: 0 (e.g. If something good would happen and I would feel like celebrating; if everything was going well).4. TESTING CONTROL OVER MY USE OF ALCOHOL OR DRUGS Selected Value: 0 (e.g. If I would start to believe that alcohol or drugs were no longer a problem for me: If I would feel confident that I could handle drugs or several drinks).5. URGES AND TEMPTATIONS Selected Value: 0 (e.g. If I suddenly had an urge to drink or use drugs; If I were in a situation where I had often used drugs or drank heavily; If I began to think of how good a rush or high had felt).6. CONFLICT WITH OTHERS Selected Value: 0 (e.g. If I had an argument with a friend; If I were not getting along well with others at work).7. SOCIAL PRESSURE TO USE Selected Value: 0 (e.g., If someone would pressure me to "be a good sport" and drink or use drugs with them; If I would be invited to someone's home and they would offer me a drink or drugs).8. PLEASANT TIMES WITH OTHERS Selected Value: 0 (e.g., If I wanted to celebrate with a friend; If I would be enjoying myself at a party and wanted to feel even better).Submit My Answers
