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How old are you now?
 
13-15
 
16-18
 
19-21
 
Older
 
 
 
How old were you when you got high/drunk for the first time?
 
13-15
 
16-18
 
19-21
 
Still not
 
 
 
Have you ever tried any illegal substances?
 
Yes
 
No
 
 
 
If your previous answer was yes, what other substances have you tried so far?
 
None
 
Weed
 
Opioids
 
Psychedelics
 
Prescription drugs (abused)
 
Other
 

 
 
 
Has your alcohol/drug use affected your social life in a negative way?
 
Yes
 
No
 
 
 
How often do you get drunk/high?
 
Several times per week
 
Once per week
 
Few times per month
 
Once per month
 
Less often
 
 
 
Is it easy for you to control your own use of intoxicants?
 
Yes
 
No
 
 
 
Have you ever done anything you have regretted after being high/drunk?
 
Yes
 
No
 
 
 
Has anything from these happened to you when you were drunk/high?
 
You have hurt yourself
 
You have hurt someone else
 
You have gotten in trouble with somebody
 
You have gotten in trouble with the police
 
None of these happened to me

 
 
 
Has this survey affected your way of thinking about the use of intoxicants?
 
Yes
 
No
 
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