Thanks for working with me to help me know a little bit more about your experiences with alcohol and/or drugs. Mark the answer that best describes your experiences, even if none of the answers seem quite right. Please pick the one that comes closest to being true.
3. How often do you use alcohol or drugs of any kind? *This question is required.
4. When did you last use alcohol or drugs of any kind? *This question is required.
5. I usually start to use alcohol or drugs because (check all that apply)... *This question is required.
6. How do you get your alcohol or drugs? *This question is required.
7. When did you first use alcohol or drugs? *This question is required.
8. What time of day do you use alcohol or drugs? Check all that apply. *This question is required.
9. Who do you use alcohol or drugs with? Check all that apply *This question is required.
10. What effects do you have from using alcohol or drugs? Check all that apply *This question is required.
11. What effect has using alcohol or drugs had on your life? Check all that apply *This question is required.
12. How do you feel about your use of alcohol or drugs? Check all that apply *This question is required.
13. How do others see you in relation to your alcohol or drug use? Check all that apply *This question is required.
14. How often have you used marijuana? *This question is required.
15. How often do you use hallucinogens like LSD, PCP, shrooms, etc.? *This question is required.
16. How often do you use amphetamines, like Ritalin, Vivance, Adderal, yellow jackets, etc. ? *This question is required.
17. How often do you use cocaine in any form or any method? *This question is required.
18. How often do you use barbituates, like Quaaludes, sopers, downers, reds? *This question is required.
19. How often do you use opiates like Oxycodone, Oxycontin, opiate/poppy tea? *This question is required.
20. How often do you use benzodiazepines like Xanex, Valium, Klonopin? *This question is required.
21. How often do you use alcohol? *This question is required.