Drug Usage Survey
M. Plonsky, Ph.D.

This survey is anonymous. It does not ask for or collect any identifying information. Please answer each question honestly by choosing the appropriate radio buttons and filling in the appropriate values. If you feel uncomfortable about a question, simply skip it. The survey consists of about 17 questions and should take less than 5 minutes of your time.

1. Code: (You were given this when asked to take the survey).
2. Gender:Female Male
3. Age:(in years)
4. Rank in College:
Freshmen
Sophomore
Junior
Senior
Other
5. Have you ever drank an alcoholic beverage?
No Yes
If yes, have you ever drank 6 or more alcoholic beverages within 2 hours?
No Yes Yes, within the last month
6. Please estimate the average number of alcoholic drinks you currently consume per week (enter a zero if you don't currently drink):
7. Have you ever been arrested for drunken driving?
No Yes
8. Have you ever tried marijuana?
No Yes Yes, within the last month
If yes, please estimate the average number of times
you currently use it per month:
9. Have you ever tried a hallucinogen (other than marijuana)?
No Yes Yes, within the last month
10. Have you tried ecstasy (or other similar designer hallucinogen)?
No Yes Yes, within the last month
11. Have you ever used a stimulant illegally (e.g., dexedrine, methamphetamine)?
No Yes Yes, within the last month
12. Have you ever tried cocaine, crack, or freebase?
No Yes Yes, within the last month
13. Have you ever used sleeping pills or tranquilizers illegally?
No Yes Yes, within the last month
14. Have you ever used an opiate illegally (e.g., codeine, morphine, heroin)?
No Yes Yes, within the last month
15. Have you ever tried an inhalant (e.g., glue, scotch guard fabric protector)?
No Yes Yes, within the last month
16. Have you ever tried an illegal drug?
No Yes Yes, within the last month
17. Have you ever been arrested for a drug related offense (other than drunk driving)?
No Yes