Assessment of Recovery Capital
Participant Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
1. I am currently sober
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
2. I feel I am in control of my substance use
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
3. I have had no "near things" about relapsing
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
4. I have had no recent instances of substance intoxication
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
5. There are more important things in life than using substances
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
6. I am able to concentrate when I need to
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
7. I am coping with the stresses in my life
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
8. I am happy with my appearance
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
9. In general I am happy with my life
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
10. What happens to me in the future mostly depends on me
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
11. I cope well with everyday tasks
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
12. I feel physically well enough to work
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
13. I have enough to complete the tasks I set myself
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
14. I have no problem getting around
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
15. I sleep well most nights
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
16. I am proud of the community I live in and feel part of it- I have a sense of belonging
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
17. It is important for me to contribute to society and be involved in activities that contribute to my community
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
18. It is important for me to do what I can to help other people
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
19. It is important for me that I make a contribution to society
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
20. My personal identity does not revolve around drug use of drinking
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
21. I am happy with my personal life
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
22. I am satisfied with my involvement with my family
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
23. I get lots of support from friends
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
24. I get the emotional help and support I need from my family
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
25. I have a special person that I can share my joys and sorrows with
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
26. I am actively involved in leisure and sports activities
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
27. I am actively engaged in efforts to improve myself (training, education and/or self-awareness)
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
28. I engage in activities that I find enjoyable and fulfilling
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
29. I have access to opportunities for career development (job opportunities, volunteering or apprenticeships)
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
30. I regard my life as challenging and fulfilling without the need for using drugs or alcohol
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
31. I am proud of my home
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
32. I am free of threat or harm when I'm at home
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
33. I feel safe and protected where I live
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
34. I feel that I am free to shape my own destiny
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
35. My living space has helped to drive my recovery journey
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
36. I am free from worries about money
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
37. I have the personal resources I need to make decisions about my future
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
38. I have the privacy I need
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
39. I make sure I do nothing that hurts or damages other people
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
40. I take full responsibility for my actions
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
41. I am happy dealing with a range of professional people
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
42. I do not let other people down
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
43. I eat regularly and have a balanced diet
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
44. I look after my health and well-being
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
45. I meet all of my obligations promptly
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
46. Having a sense of purpose in my life is important to my recovery journey
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
47. I am making good progress on my recovery journey
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
48. I engage in activities and events that support my recovery
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
49. I have a network of people I can rely on to support my recovery
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
50. When I think of the future, I feel optimistic
Not at all true
Somewhat true
Pretty much true
Very much true
Completely true
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