You are on page 1of 6

CTCR

CENTERFORTHERAPEUTICCOMMUNITYRESEARCH

CIRCUMSTANCES,MOTIVATION,andREADINESS
SCALESforSUBSTANCEABUSETREATMENT

CMRFACTORSCALES
IntakeVersion

CLIENTIDNUMBER...........................................(___/___/___/___/___/___/___/___) (18)

CLIENTGENDER...................................................................................................(___) (9)
1=Male 2=Female

CLIENTETHNICITY..............................................................................................(___) (10)
1=AfricanAmerican 2=Hispanic 3=White 4=Other

CLIENTAGE....................................................................................................(___/___) (1112)

PRIMARYDRUG.............................................................................................(___/___) (1314)
1=Noncrackcocaine 5=Alcohol
2=Crack 6=PolyDrug
3=Opiates 8=Other
4=Marijuana

TREATMENTMODALITY.............................................................................(___/___) (1516)
1=DrugFreeOutpatient 7=NoTreatmentEntered
2=DayTreatment 8=DetoxificationOnly
3=MethadoneMaintenance 9=DetoxificationasEntryintoTreatment
4=BriefResidential(03months)10=HospitalInpatient
5=ShortTermResidential(4to6months)11=ReferralCenter
6=LongTermResidential(Morethan6months)12=Other

DATEOFADMINISTRATION..........................................(___/___/___/___/___/___) (1722)

FORCTCRUSEONLY.PLEASELEAVEBLANK.

Copyright1993byGeorgeDeLeon,Ph.D.,Director,CenterforTherapeutic
CommunityResearch(CTCR)atNDRI,Inc.,71West23rdStreet,8thFl.,NewYork,NY
10010.Allrightsreserved.Nopartofthismaterialmaybereproducedinanyformof
printingorbyanyothermean,electronicormechanical,includingbutnotlimitedto
photocopying,audiovisualrecordingandtransmission,andportrayalorduplicationinany
informationstorageandretrievalsystem,withoutpermissioninwritingfromtheauthor.
INSTRUMENTVERSION......................................................................................(___) (23)

PROGRAMNUMBER.....................................................................................(___/___) (2425)
October26,1998Revision

Copyright1993byGeorgeDeLeon,Ph.D.,Director,CenterforTherapeutic
CommunityResearch(CTCR)atNDRI,Inc.,71West23rdStreet,8thFl.,NewYork,NY
10010.Allrightsreserved.Nopartofthismaterialmaybereproducedinanyformof
printingorbyanyothermean,electronicormechanical,includingbutnotlimitedto
photocopying,audiovisualrecordingandtransmission,andportrayalorduplicationinany
informationstorageandretrievalsystem,withoutpermissioninwritingfromtheauthor.
Howyoufeelcanhaveapowerfuleffectontreatment.Thesefeelingsincludeyourcircumstances,the
problems inyourlife, yourfeelings aboutyourself,andyourfeelings abouttreatment. Carefully
considereachofthequestionsbelowandindicatehowcloselytheydescribeyourownthoughtsand
feelings.

Circlethenumberthatbestdescribesyourresponse.

1 2 3 4 5 9
Strongly Disagree Neither Agree Strongly Not
Disagree AgreeorDisagree Agree Applicable

1. IamsurethatIwouldgotojailifIdidn't 123459 ___ (26)


entertreatment.

2. IamsurethatIwouldhavecometotreatment 123459 ___ (27)


withoutthepressureofmylegalinvolvement.

3. Iamsurethatmyfamilywillnotletmelive 123459 ___ (28)


athomeifIdidnotcometotreatment.

4. Ibelievethatmyfamily/relationshipwilltryto 123459 ___ (29)


makemeleavetreatmentafterafewmonths.

5. IamworriedthatIwillhaveseriousmoney 123459 ___ (30)


problemsifIstayintreatment.

6. Basically,IfeelIhavetoomanyoutside 123459 ___ (31)


problemsthatwillpreventmefromcompleting
treatment(parents,spouse/relationship,children,
lossofjob,lossofincome,lossofeducation,
familyproblems,lossofhome/placetolive,etc.).

7. Basically,Ifeelthatmydruguseisavery 123459 ___ (32)


seriousprobleminmylife.

8. OftenIdon'tlikemyselfbecauseofmydruguse. 123459 ___ (33)

9. Lately,IfeelifIdon'tchange,mylifewillkeep 123459 ___ (34)


gettingworse.

10. Ireallyfeelbadthatmydruguseandtheway 123459 ___ (35)


I'vebeenlivinghashurtalotofpeople.

2
11. Itismoreimportanttomethananythingelse 123459 ___ (36)
thatIstopusingdrugs.

3
1 2 3 4 5 9
Strongly Disagree Neither Agree Strongly Not
Disagree AgreeorDisagree Agree Applicable

12. Idon'treallybelievethatIhavetobein 123459 ___ (37)


treatmenttostopusingdrugs,Icanstop
anytimeIwant.

13. IcametothisprogrambecauseIreallyfeel 123459 ___ (38)


thatI'mreadytodealwithmyselfintreatment.

14. I'lldowhateverIhavetodotogetmylife 123459 ___ (39)


straightenedout.

15. Basically,Idon'tseeanyotherchoiceforhelp 123459 ___ (40)


atthistimeexceptsomekindoftreatment.

16. IdontreallythinkIcanstopmydrugusewith 123459 ___ (41)


thehelpoffriends,familyorreligion,Ireally
needsomekindoftreatment.

17. Iamreallytiredofusingdrugsandwantto 123459 ___ (42)


change,butIknowIcan'tdoitonmyown.

18. Imwillingtoentertreatmentassoonaspossible. 123459 ___ (43)

4
1

10

11

12

13

14

15

16

17

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43