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How often do you normally use: (DARKEN ONE BUBBLE FOR EACH LINE: a-l.)
Never used it
Every day
Several times a week
Several times a month
About once a month
About once a year
Less than once a year
a. Tobacco?
b. Alcohol?
c. Inhalants (whiteout, spray paint, glue, gas, etc.) to get high?
d. Marijuana?
e. Cocaine (not crack)?
f. Crack?
g. Blamaril?
h. Steroids
i. Ecstasy?
j. Heroin (black tar, cheese, chiva, brown heroin)?
k. Methamphetamine (speed, crystal meth, ice, or crank)?
l. Synthetic Marijuana (spice, K2)?
When you drink alcoholic beverages, how many drinks do you usually have AT ONE TIME, on average: (DARKEN ONE BUBBLE FOR EACH LINE: a-d.)
Never drink this beverage
12 or more drinks
9-11 drinks
5-8 drinks
3-4 drinks
2 drink
1 drink
Less than 1 drink
a. Beer
b. Wine Coolers (hard lemonade, hard sodas, hard ciders, etc.)
c. Wine
d. Liquor (vodka, rum, whiskey, etc.)
IN THE PAST 30 DAYS, on how many days have you had 5 or more drinks of alcohol in a two-hour period?
Never had 5 or more drinks in two-hour period
None
1 day
2 days
3 to 5 days
6 to 9 days
10 or more days
a. Alcohol
How often do you get alcoholic beverages from the following sources: (DARKEN ONE BUBBLE FOR EACH LINE: a-e.)
Do Not Drink
Never
Seldom
Most of the time
Always
a. At home
b. From friends
c. From a store
d. At parties
e. Other source
How dangerous do you think it is for kids your age to use: (DARKEN ONE BUBBLE FOR EACH LINE: a-m)
Very Dangerous
Somewhat Dangerous
Not very Dangerous
Not Dangerous At All
Don't Know
a. Tobacco?
b. Alcohol?
c. Inhalants (Whiteout, spray paint, glue, gas, etc.)?
d. Marijuana?
e. Cocaine (not crack)?
f. Crack?
g. Ecstasy?
h. Steroids?
i. Heroin (black tar, cheese, chiva, brown heroin)?
j. Methamphetamine (speed, crystal meth, ice, or crank)?
k. Synthetic Marijuana (spice, K2)
l. Any prescription drug not prescribed to you?
m. Electronic Vapor Products (E-Cigarettes, E-Cigars, Vaping Pens, Vape Pipes, etc.)?