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 Agree
4. Agree
3. Sometimes
2. Disagree
1. 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-term
recovery.
Text field___ I continue to participate in a continuing care program of an addiction treatment
program, (e.g., groups, alumni association meetings, etc.)
Text field___ I have a professional assistance program that is monitoring and supporting my
recovery 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.