Recovery Capital Scale
Client first nameClient last name
CheckboxesI am filling this out for myself OR
CheckboxesSomeone else is filling this out for me.
Place a number by each statement that best summarizes your situation.
5. Strongly Agree4. Agree3. Sometimes2. Disagree1. Strongly Disagree
Text field___ I have the financial resources to provide for myself and my family.Text field___ I have personal transportation or access to public transportation.Text field___ I live in a home and neighborhood that is safe and secure.Text field___ I live in an environment free from alcohol and other drugs.Text field___ I have an intimate partner supportive of my recovery process.Text field___ I have family members who are supportive of my recovery process.Text field___ I have friends who are supportive of my recovery process.Text field___ I have people close to me (intimate partner, family members, or friends) who are also in recovery.Text field___ I have a stable job that I enjoy and that provides for my basic necessities.Text field___ I have an education or work environment that is conducive to my long-termrecovery.Text field___ I continue to participate in a continuing care program of an addiction treatmentprogram, (e.g., groups, alumni association meetings, etc.)Text field___ I have a professional assistance program that is monitoring and supporting myrecovery process.Text field___ I have a primary care physician who attends to my health problems.Text field___ I am now in reasonably good health.
Text field___ I have an active plan to manage any lingering or potential health problems.Text field___ I am on prescribed medication that minimizes my cravings for alcohol and other drugs.Text field___ I have insurance that will allow me to receive help for major health problems.Text field___ I have access to regular, nutritious meals.Text field___ I have clothes that are comfortable, clean and conducive to my recovery activities.Text field___ I have access to recovery support groups in my local community.Text field___ I have established close affiliation with a local recovery support group.Text field___ I have a sponsor (or equivalent) who serves as a special mentor related to my recovery.Text field___ I have access to Online recovery support groups.Text field___ I have completed or am complying with all legal requirements related to my past.Text field___ There are other people who rely on me to support their own recoveries.Text field___ My immediate physical environment contains literature, tokens, posters or other symbols of my commitment to recovery.Text field___ I have recovery rituals that are now part of my daily life.Text field___ I had a profound experience that marked the beginning or deepening of my commitment to recovery.Text field___ I now have goals and great hopes for my future.Text field___ I have problem solving skills and resources that I lacked during my years of active addiction.Text field___ I feel like I have meaningful, positive participation in my family and community.Text field___ Today I have a clear sense of who I am.Text field___ I know that my life has a purpose.Text field___ Service to others is now an important part of my life.Text field___ My personal values and sense of right and wrong have become clearer and stronger in recent years.