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Exit Survey
 
 
With which gender do you identify?
 
Male
 
Female
 
Other
 
 
 
In which age bracket do you fall?
 
18-22 years
 
23-27 years
 
28-34 years
 
35+ years
 
 
 
What is your current occupation? (Select all that apply)
 
Full-time student
 
Part-time student
 
Apprentice/trainee
 
Employed casually/part-time
 
Employed full time
 
Not currently employed

 
 
In the past 6 months, how many times (if at all) have you used the following recreational drugs?
0 times 1-2 times 3-4 times 5-9 times 10+ times
Alcohol
Marijuana
E/MDMA
Cocaine
Methamphetamine
GHB
Ketamine
 
 
On a scale of 0-3 (0 = never; 3 = severe) to what extent have you experienced the following potential long-term harms (i.e in the weeks or months following) of E/MDMA use?
0 (never) 1 (minimal) 2 (moderate) 3 (severe) Not sure
Psychological effects (anxiety, depression, mood swings)
Reduced cognitive ability/efficiency
Insomnia/difficulty sleeping
Addiction/dependance on drugs to 'have fun'
Financial difficulties
Relationship problems (friends, family, significant other)
Negative impact on student/job performance
Negative impact on overall quality of life
 
 
On a scale of 0-3 (0 = not very/not at all; 3 = extremely) how concerned are you about the following potential long term harms of E/MDMA use?
0 (not very/not at all) 1 (mildly concerned) 2 (moderately concerned) 3 (extremely concerned) Not sure
Psychological effects (anxiety, depression, mood swings)
Reduced cognitive ability/efficiency
Insomnia/difficulty sleeping
Physical wellbeing
Addiction/dependence on drugs to 'have fun'
Criminal sanctions from police
Other sanctions (Eg. banning) from venue/event personnel
Financial difficulties
Relationship problems (friends, family, significant other)
Negative impact on student/job performance
Negative impact on overall quality of life
 
 
 
Rank from top to bottom the following factors in terms of their likelihood to influence the reduction or desistance of your E/MDMA use: 
Drag your choices here to rank them
     
     
    To what extent do you agree/disagree with the following statements:
    Strongly disagree Disagree Agree Strongly agree Not sure/Not applicable
    I plan on reducing my E/MDMA use in the next 6-12 months
    I plan on ceasing E/MDMA use in the next 6-12 months
    I plan on increasing my E/MDMA use in the next 6-12 months
    I have ceased E/MDMA use
    I moderate the frequency of my E/MDMA use (how often)
    I moderate the intensity of my E/MDMA use (how much E/MDMA per use)
    E/MDMA use is a phase that people grow out of
    The impacts of criminal sanctions for recreational drug use are more harmful than recreational drug use itself
    People who use E/MDMA are likely to become addicts
     
     
     
    Rank in order from most useful (1) to least useful (8) how useful the following sources of information are regarding the potential harms of E/MDMA use: 
    (If a category does not apply to you please leave it blank)
    Peers or siblings
    Personal experience
    Workmates
    Government campaigns
    Non-government campaigns
    High school education
    University education
    Self-guided research
     
     
     
    Do you have anything else you wish to add? Please provide any additional information, comments or feedback in the space below: