DVI-J

Instructions
You are completing this inventory to give
the staff information that will help them
understand your situation and needs.
The statements are numbered.
Each
statement must be answered. Read each
statement carefully and choose the answer
that is accurate for you. Do not skip any
statements.
Do not lie or give false information.
Dishonesty can be detected. This inventory
measures how truthful and cooperative you
are. In addition, your court-related records
may be used to check the information you
provide.
Alcohol or drinking refers to beer, wine or
other liquors. Drugs refer to marijuana
(pot), cocaine (coke), downers, crack, ice,
barbiturates, amphetamines and heroin.
Do not make any marks on this booklet.
Mark all of your answers on the answer
sheet. First, fill in the information at the top
of your answer sheet. Then, starting with
statement one, answer every statement.
Section 1
The following statements must be answered
True or False. If a statement is True, put an
X under T for True on your answer sheet. If
a statement is False, put an X under F for
False. All statements must be answered.
1. There are times when I get real
discouraged.
2. When I drink my personality changes
and I seem like a different person.
3. There are times when I am not getting
my way that I will bully, browbeat and
argue until I do.
4. I have used drugs more than I should.
5. I get into a lot of arguments and fights.
6. Sometimes I worry about what people
think or say about me.
7. There are times when I feel guilty about
my drinking.

8. Family and friends complain that I am

always telling them how they should do
things.
9. My use of drugs has caused family or
social problems for me.
10. Sometimes I will nag, pester and beg for
what I want until I get it.
11. When I get angry or upset I often yell or
break things.
12. There are times when I am really down,
depressed and discouraged.
13. Smoking marijuana or using cocaine
helps me settle down and feel good.
14. Even though I drink, I usually deny
drinking or say I drink less then I really do.
15. I have an explosive temper.
16. I have been embarrassed at school by
mistakes I have made.
17. Sometimes I drink too much.
18. People have told me I am arrogant,
demanding and controlling.
19. When offered drugs, I may or may not use
them. It depends on how I feel at the time.
20. I have threatened to run away from home if
I didnt get my way.
21. I was not caught for some of the things I
have done that were wrong.
22. I have lied to people about my drinking -either minimizing how much I really drink,
or hiding the fact that I drink at all.
23. To get what I want, I often get angry, shout
or become demanding.
24. After using drugs, I have seen or heard
things that were not really there.
25. I have serious family problems.
26. I have done things when angry that I later
regretted.
27. I have been told I have a drinking problem.
28. People that know me understand that when
I am angry I push, shove and hit.
29. Within the last year, I have been using
more drugs to get the same effect.
30. Sometimes I just cannot control my
temper.
31. My drinking is more than just a little or
minor problem.

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32.
33.
34.
35.
36.
37.
38.

39.
40.
41.
42.
43.
44.
45.
46.
47.
48.

49.
50.
51.
52.
53.
54.

There have been times when I did

something wrong and was not caught.
There are times when I feel guilty about
using drugs.
When annoyed or frustrated I tend to fly
off the handle and lash out at people.
I was surprised when I saw the bruises I
inflicted on a family members body.
I know I shouldnt but I have been
jealous of someone elses success.
In the last year, drinking has been a
problem for me.
Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Insistent or demanding
b. Threatening or intimidating
c. Commanding or dominating
d. Swearing or verbally abusive
e. Manipulative or controlling
I have a drug-related problem.
I often think about revenge and how I can
get even.
There are times when family members
frustrate or irritate me.
I have asked for help with my drinking
problem.
I have a forceful personality and usually
control or dominate others.
Within the last year, I have used drugs to
relax or feel good.
I have threatened or physically hurt a
member of my family.
It bothers me when I am overlooked or
ignored by people I know.
I am concerned about my drinking.
Members of my family say they stay out
of my way because they want to avoid an
argument or confrontation with me.
My use of drugs has threatened my
happiness and success in life.
When I get angry I can be dangerous.
I do not have a drinking problem.
When upset or mad I often shout, swear
and put other people down.
There are times when I worry about my
court case or the charges made against me.
It is important for me to be in charge.

55. I regret some of the things I have said or done.

56. I go to Alcoholics Anonymous (AA)
because of my drinking.
57. To get what I want I sometimes pout and
give the other person the silent treatment
until they give in.
58. I have lied about my use of drugs -- either
minimizing how much I use, or hiding the
fact that I use drugs at all.
59. I need help to overcome my drinking
problem.
60. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Threatening
b. Explosive
c. Dangerous
d. Violent
e. Hostile
61.
62.
63.

64.
65.
66.

There are times when I daydream about

being rich or famous.
I have had two or more memory losses
(blackouts) after drinking.
I often get people to do things by making
them feel guilty (like they did something
wrong) if they dont.
I have gone to someone for help with my
drug problem.
If someone insults or hurts me I usually
try to get even.
There are times when I really worry
about myself and my happiness.

67.

Within the last year, my family has been

concerned about my drinking.

68.

Some members of my family say I make

their guests, friends or visitors feel
uncomfortable or unwelcome in our home.
I use and sometimes abuse drugs.
There are times at home when I get really
frustrated and angry.
Within the last year, I drank alcohol to
avoid or escape from worries.
In many relationships one person dominates
and the other person submits to their control.
I usually dominate and control.
There have been times when I have been
physically cruel to someone and
deliberately hurt them.

69.
70.
71.
72.

73.

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75.
76.
77.
78.
79.
80.

81.
82.
83.
84.
85.
86.
87.

88.
89.
90.

91.
92.
93.
94.
95.
96.
97.

I have been treated in a chemical

dependency program for a drug problem.
There have been times have I have been
worried that others may think badly of me.
When I am really upset, I get in the other
persons face and say things to hurt them.
I have a lot of problems and conflicts
with people.
When I think about some of the things I
have done I get discouraged or upset.
I have a drinking problem.
Now that I think of it, I pretty much
choose what TV shows we watch at
home.
There are times when I am very unhappy.
After losing control, I say I will never do
it again, but always do.
I am concerned about my drug use.
When angry I sometimes lose control and
unintentionally hurt or abuse others.
I am worried about hurting members of
my family.
I do not always tell the whole truth when
asked about my personal life.
I am a recovering alcoholic. I have an
alcohol problem, but do not drink
anymore.
I am often irritable, moody or
demanding.
I have pushed or hit family members.
I go to Narcotics Anonymous (NA) or
Cocaine Anonymous (CA) meetings
because of my drug use.
I can be rigid, persistent and demanding
until I get what I want.
I can be dangerous when frustrated,
angered or insulted.
I am a controlling person in that I usually
get family and friends to do things my way.
There are times I get so angry I cannot
control myself.
I am in counseling or treatment for a drug
problem.
At times I get angry and upset at myself.
I do not like to watch TV unless I am the
one holding the TV controller.

Section 2
Rate yourself by selecting the number that
describes you best. Use one of the following
for your answer:
1. Rare or Never
3. Often

2. Sometimes
4. Very Often

Put an X on your answer sheet under the

number (1, 2, 3, or 4) that applies to you.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.

Self Control / Compose

Headaches / Migraines
Positive Attitude / Outlook
Dissatisfied with Life
Good Sense of Humor / Laugh
Cant Make Decisions / Indecisive
Depressed / Discouraged
Alcohol / Drugs
Manage Time Effectively
Insomnia / Trouble Sleeping
Satisfied with Self / Like Self
Feel Inadequate / Inferior
Emotionally Stable / Level Headed
Enthusiastic / Involved with Life
Tension / Stress
Emotionally Upset / Crying
Share My Thoughts Comfortably
Angry / Hostile with Others
Lonely / Unhappy
Able to Handle Lifes Problems
Nervous / Unable to Relax
Patient / Tolerant / Understanding
Directly Deal with Problems
Accept Constructive Criticism
Express Feelings Comfortably
Stomach Problems / Acidity
Difficulty with Others / Friction
Family Problems
Self Reliant / Independent
Satisfied / Contented with Life
Family Problems / Conflict
Blow-up / Rage / Explode
Manipulative / Controlling

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Section 3
Several available community resources and
program are listed below. Put an X on your
answer sheet under Y (for Yes) if you want to
participate, or continue to participate, in a
program. Put an X under N (for No) if you do
not want to participate. Each item must be
answered Yes or No.
131. Alcohol Treatment
132. Alcoholics Anonymous
133. Anger Management
134. Cocaine Anonymous
135. Domestic Violence Counseling
136. Drug Treatment
137. Narcotics Anonymous
138. Counseling
139. Relaxation Training
140. Temper Control
Section 4
Answer the following statements to describe
yourself. Put an X under the number (1, 2, 3,
or 4) on our answer sheet that is accurate for
you.
141. How would you describe your temper?
1. A serious problem
2. A moderate problem
3. A slight or mild problem
4. Not a problem
142. How would you describe your
drinking?
1. A serious problem
2. A moderate problem
3. A slight or mild problem
4. Not a problem
143. How would you describe your use of
drugs?
1 A serious problem
2 A moderate problem
3 A slight or mild problem
4 Not a problem

144. How would you describe your

domestic violence?
1. A serious problem
2. A moderate problem
3. A slight or mild problem
4. Not a problem
145. How would you describe your desire to
get alcohol treatment?
1. Want help (highly motivated)
2. May need help (moderately
motivated)
3. Not sure (slightly motivated)
4. No need (not motivated)
146. How would you describe your desire to
get drug treatment?
1. Want help (highly motivated)
2. May need help (moderately
motivated)
3. Not sure (slightly motivated)
4. No need (not motivated)
147. How would you describe your desire to
get domestic violence counseling?
1. Want help (highly motivated)
2. May need help (moderately
motivated)
3. Not sure (slightly motivated)
4. No need (not motivated)
148. During the last year, I have had
serious:
1. Emotional problems
2. Mental health problems
3. Both 1 and 2 (emotional and
mental health problems)
4. None of the above
149. During the last year, I have been:
1. Dangerous to myself (suicidal)
2. Dangerous to others (homicidal)
3. Both 1 and 2 (suicidal and
homicidal)
4. None of the above

Thank you for your cooperation.

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DVI-J

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
1. ____ ____

33. ____ ____

65. ____ ____

2. ____ ____

34. ____ ____

66. ____ ____

3. ____ ____

35. ____ ____

67. ____ ____

4. ____ ____

36. ____ ____

68. ____ ____

5. ____ ____

37. ____ ____

69. ____ ____

6. ____ ____

38. ____ ____

70. ____ ____

7. ____ ____

39. ____ ____

71. ____ ____

8. ____ ____

40. ____ ____

72. ____ ____

9. ____ ____

41. ____ ____

73. ____ ____

10. ____ ____

42. ____ ____

74. ____ ____

11. ____ ____

43. ____ ____

75. ____ ____

12. ____ ____

44. ____ ____

76. ____ ____

13. ____ ____

45. ____ ____

77. ____ ____

Education (Highest grade completed):

14. ____ ____

46. ____ ____

78. ____ ____

Identification Number:

15. ____ ____

47. ____ ____

79. ____ ____

16. ____ ____

48. ____ ____

80. ____ ____

17. ____ ____

49. ____ ____

81. ____ ____

18. ____ ____

50. ____ ____

82. ____ ____

19. ____ ____

51. ____ ____

83. ____ ____

1. Your age at your first conviction:

_______ 20. ____ ____

52. ____ ____

84. ____ ____

2. Number of times on probation:

_______

21. ____ ____

53. ____ ____

85. ____ ____

22. ____ ____

54. ____ ____

86. ____ ____

3. Number of probation revocations:

_______ 23. ____ ____

55. ____ ____

87. ____ ____

4. Number of juvenile court hearings:

_______ 24. ____ ____

56. ____ ____

88. ____ ____

25. ____ ____

57. ____ ____

89. ____ ____

26. ____ ____

58. ____ ____

90. ____ ____

6. Number of times in juvenile confinement: _______ 27. ____ ____

59. ____ ____

91. ____ ____

7. Number of domestic violence arrests:

_______ 28. ____ ____

60. ____ ____

92. ____ ____

8. Number of alcohol-related arrests:

_______

29. ____ ____

61. ____ ____

93. ____ ____

30. ____ ____

62. ____ ____

94. ____ ____

9. Number of drug-related arrests:

_______ 31. ____ ____

63. ____ ____

95. ____ ____

32. ____ ____

64. ____ ____

96. ____ ____

ANSWER SHEET
COMPLETE THE FOLLOWING
INFORMATION
First Name:
Last Name:
Middle Initial:
Last Four Digits of your SSN:
Age:

Sex:

Ethnicity (Race):
Date of birth:

Todays Date:

In the following, number means the total

number in your lifetime.

5. Number of times in juvenile detention: _______

10. Number of assault (not domestic

violence) arrests:

_______

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97. ____ ____

Section 2
Put an X under the number (1, 2, 3, or 4) that describes you best. Use the following scale to select your answers.
1. Rare or Never 2. Sometimes 3. Often 4. Very Often
1

98. ____ ____ ____ ____

109. ____ ____ ____ ____

120. ____ ____ ____ ____

99. ____ ____ ____ ____

110. ____ ____ ____ ____

121. ____ ____ ____ ____

100. ____ ____ ____ ____

111. ____ ____ ____ ____

122. ____ ____ ____ ____

101. ____ ____ ____ ____

112. ____ ____ ____ ____

123. ____ ____ ____ ____

102. ____ ____ ____ ____

113. ____ ____ ____ ____

124. ____ ____ ____ ____

103. ____ ____ ____ ____

114. ____ ____ ____ ____

125. ____ ____ ____ ____

104. ____ ____ ____ ____

115. ____ ____ ____ ____

126. ____ ____ ____ ____

105. ____ ____ ____ ____

116. ____ ____ ____ ____

127. ____ ____ ____ ____

106. ____ ____ ____ ____

117. ____ ____ ____ ____

128. ____ ____ ____ ____

107. ____ ____ ____ ____

118. ____ ____ ____ ____

129. ____ ____ ____ ____

108. ____ ____ ____ ____

119. ____ ____ ____ ____

130. ____ ____ ____ ____

Section 3
Put an X under Y for Yes if you are interested in participating in the listed program. Put an X under N for No if
you are not interested in participating.
Y
N
Y
N
131. _____ _____
136. _____ _____
132. _____ _____

137. _____ _____

133. _____ _____

138. _____ _____

134. _____ _____

139. _____ _____

135. _____ _____

140. _____ _____

Section 4
Put an X under the number (1, 2, 3, or 4) that is most accurate for you.
1
2
3
4
141.____ ____ ____ ____

1
2
3
4
144.____ ____ ____ ____

1
2
3
4
147.____ ____ ____ ____

142.____ ____ ____ ____

145.____ ____ ____ ____

148.____ ____ ____ ____

143.____ ____ ____ ____

146.____ ____ ____ ____

149.____ ____ ____ ____

Please turn your inventory booklet and answer sheet in to the testing supervisor.
Thank you for your cooperation!

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