Addiction Treatment Alternatives Information - http://www.addictioninfo.org
Cocaine: Decision Balance
http://www.addictioninfo.org/articles/346/1/Cocaine-Decision-Balance/Page1.html
Cancer Prevention Research Center
The primary mission of CPRC - the Cancer Prevention Research Center - is to enhance the quality and quantity of life through prevention of cancer, other chronic diseases and premature death. 
By Cancer Prevention Research Center
Published on 12/29/2005
 
A list of statements about deciding whether or not to use cocaine.
PROS AND CONS:

The following statements represent different opinions about cocaine. Please rate HOW IMPORTANT each statement is to you in deciding whether or not to use cocaine according to the following 5 point scale with 5 = Extremely important and 1 = Not important.

5 = Not Important
4 = A little bit important
3 = Somewhat important
2 = Quite important
1 = Extremely Important

1. I feel better about myself while using cocaine.
  
2. Cocaine makes me feel more confident and sociable.
  
3. I am more fun to be with when I use cocaine.
  
4. My cocaine use has led me to act irresponsibly.
  
5. I feel more confident when I use cocaine.
  
6. When using cocaine I fail to keep up with bills.
  
7. Cocaine helps me relieve tension.
  
8. As I became more involved with cocaine, I pulled away from people I was once close to.
  
9. When using cocaine, I borrow money which I fail to pay back.
  
10.  Cocaine gives me that extra boost of energy.
  
11.  Buying cocaine has contributed to my experiencing some financial strain.
  
12.  I experience sleep problems when I use cocaine.
  

References
Prochaska, J. O., W. F. Velicer, et al. (1994). "Stages of change and decisional balance for 12 problem behaviors." Health Psychology 13: 39-46.