III. Reinstatement Review. Inventory At times I worry about what people think or say about me. 12. I have a drug problem.

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1 Reinstatement Review III 14. Inventory - This questionnaire measures your cooperation and truthfulness. And your records will be reviewed to verify the information provided. Read each statement carefully and mark your answer sheet accurately. There are no trick questions. Complete the information at the top of your answer sheet. Do not skip any questions. When you understand these instructions you may begin. Section 1 Answer the following statements True or False on your answer sheet. Put an X under T for True, or put an X under F for False. 1. I do not always tell the whole truth when asked about personal matters. 2. I get upset when others criticize me. 3. There are times when I am very unhappy. 4. I am in counseling or treatment for my drug problem. 5. There have been times when I have been jealous or resentful of others. 6. I have a drinking problem. 7. At times I get upset and angry at myself. 8. I am a recovering drug abuser. Even though I don t use drugs anymore, I still have a drug problem. 9. I have said and done things when angry or mad that I regret. 10. I have not had a drink (beer, wine or other liquor) since my driver s license was revoked. 11. At times I worry about what people think or say about me. 12. I have a drug problem. 13. There have been times while driving when another driver made me very angry. I am in counseling or treatment for my drinking problem. 15. There are times when I am really down and depressed. 16. I am a recovering alcoholic. Even though I don t drink anymore, I have an alcohol-related problem. 17. I have been offended or hurt by what someone said about me. 18. I have been arrested in the last year for an alcohol-related offense. 19. There are times when I get very frustrated and discouraged. 20. It bothers me when I am overlooked or ignored by people I know. 21. I attend Narcotics Anonymous (NA) or Cocaine Anonymous (CA) meetings for my drug problem. 22. I have done things that were wrong, but I was not caught. 23. I have been embarrassed and worried about mistakes I have made. 24. I attend Alcoholics Anonymous (AA) meetings for my drinking problem. 25. There are times when I worry about myself and my happiness. 26. In the last year I have been arrested for a drug-related offense. 27. Sometimes I get really angry. 28. I have used marijuana (pot) since my driver s license was revoked. 29. There have been times when I have had a job but did not want to go to work. 1

2 Section 2 Since your last arrest or ticket have you done any of the following? Put an X under the number on your answer sheet that represents your answer. Select one answer from the four (1, 2, 3 or 4) listed below. 1. Yes 2. No 3. I don t know 4. Doesn t apply to me 30. Attended AA, NA or CA meetings 31. Shown more concern for others (empathy, sympathy and caring) 32. Had counseling (professional assistance) 33. Attended defensive driving classes (improved driving skills) 34. Improved my driving attitude (controlled anger or aggressiveness) 35. Improved my family relationships (improved or developed) 36. Attended group counseling (group assistance with a counselor) 37. Attended individual counseling (one-toone counseling) 38. Resolved interpersonal problems (found ways to get along better) 39. Made life adjustments (committed to improving my life) 40. Made lifestyle changes (directed life away from problems) 41. Made new friends (made friends that don t drink to excess) 42. Participated in more recreational activities (cards, golf, etc.) 43. Had relapse prevention treatment 44. Increased my religious involvement (church, prayer and people) 45. Attended self-help groups (substance abuse-related) 46. Changed my social activities (sought new activities that don t involve drinking or using drugs) 47. Resolved my social problems (reduced interpersonal conflict) 48. Stopped drinking (beer, wine and alcohol) 49. Stopped driving (automobile, truck, etc.) 50. Stopped substance abuse (alcohol and other drugs) 51. Had substance abuse treatment (alcohol/drugs treatment) 52. Attended a twelve-step program (self-help meetings) 53. Spent more time with my family (improved quality time) 54. Improved my work or job performance (improved as needed) Section 3 How has your behavior changed since your driver s license was revoked? Put an X under the number on your answer sheet that represents your answer. Select only one of the following four answers for each item. 1. Worse 3. Better 2. No Change 4. Does not apply to me 55. Anger or temper control 56. Drinking and driving 57. Your driving attitude 58. Your abstaining and recovery 59. AA, NA or CA meetings 60. Your contentment or wellbeing 61. Commitment to positive change 62. Driver education knowledge 63. Your desire to abstain or not drink 64. Your awareness of driving safety 65. Your attitude toward drinking 66. Your desire to remain sober 2

3 Section 3, continued 67. Family relationships 68. Your impulsiveness 69. Healing (body, mind & spirit) 70. Problems and concerns 71. Understanding of substance use 72. Social-life change 73. Your attitude toward drug use Section 5 Select the answer to each of the following statements that is accurate for you. Put an X under the number (1, 2, 3 or 4) that applies to you now. 94. With regard to my abstinence/recovery program, I am at the: 1. Beginning 2. Middle 3. End 4. Long term commitment 95. At this time my abstinence/recovery 74. Your understanding of recovery program needs: 1. A completion date 75. Friendships 2. To be continued 76. Lifestyle changes 3. It s an important part of my lifestyle 4. To end. I m OK now 77. Stress and pressure Section 4 How often do you do or experience the following? Put an X beneath the number (1, 2, 3 or 4) that is accurate for you. Select one of the four choices listed below. 1. Rare or Never 3. Often 2. Sometimes 4. Very Often or Always 78. Exercise / Physical Activity 79. Positive Attitude / Outlook 80. Difficulty with Others / Conflict 81. Satisfied with Self / Like Self 82. Tense / Worried / Troubled 83. Adaptable / Adjustable 96. In the future I plan on: 1. Drinking socially but responsibly 2. Setting a drinking limit 3. Drinking occasionally but carefully 4. Not drinking anymore 97. At this time it is my belief that my abstinence/recovery: 1. Is very important to me 2. Has had a positive effect 3. Has not really effected me 4. Will soon be over for me 98. At this time how would you describe your drinking? 1. A serious problem 2. A moderate problem 3. A mild problem 4. Not a problem 99. At this time how would you describe your 84. Job / Work Satisfaction drug use? 1. A serious problem 85. Anxious / Worried / Fearful 2. A moderate problem 86. Accept Constructive Criticism 3. A mild problem 87. Admit My Errors / Mistakes 4. Not a problem 88. Nervous / Unable to Relax 100. The word recovery means having a substance (alcohol and/or other drugs) 89. Problems / Friction / Conflict abuse problem, but not drinking or using 90. Good Sense of Humor / Laugh drugs anymore. I am a recovering: 1. Alcoholic 91. Angry / Hostile with Others 2. Drug Abuser 92. Depressed / Discouraged / Unhappy 3. Both 1 and 2 4. None of the above 93. Overly Sensitive / Feelings Easily Hurt Copyright All Rights reserved. 3

4 RRI-III Answer Sheet Name or ID: Age: Sex: Date of Birth: / / Education (Highest Grade Completed): Driver s License #: Race: Marital Status: Total number of DUI/DWI arrests in lifetime: Number of alcohol-related arrests in lifetime: Number of drug-related arrests in lifetime: I understand that any false or misleading answer can result in continued suspension or revocation of my driver s license. Applicant Signature Date Section 1 If a statement is True put an X under T for True. If a statement is False put an X under F for False. T F T F T F T F T F Section 2 Put an X under the number that represents your answer. Select 1. for Yes, 2. for No, 3. for I don t know, and 4. for Doesn t apply to me

5 Section 3 Put an X under the number on your answer sheet that represents your answer. Select only one of the following four answers for each item. 1. Worse, 2. No change, 3. Better, 4. Does not apply to me Section 4 Place an X beneath the number (1, 2, 3 or 4) that is accurate for you. Select one of the following four choices. 1. Rare or Never, 2. Sometimes, 3. Often, 4. Very Often or Always Section 5 Select the answer to each of the following statements that is accurate for you. Put an X under the number (1, 2, 3 or 4) that applies to you now Thank you for your cooperation. Please return your booklet and this answer sheet to the testing supervisor.