Whats the Damage Survey

Thank you for taking the time to complete our survey.
"What's the damage" is being administered by the Health Improvement service at NHS Lancashire care foundation trust in partnership with the Lancashire Alcohol Network

During Alcohol Awareness week 2011, "What's the Damage?" will help us to understand the real & hidden consequences of alcohol consumption and misuse in the population of Lancashire.
If the survey raises any issues for you and you need more support in dealing with an alcohol related problem please find details of treatment services in your area on our Facebook page. Please join our network group on Facebook
http://facebook.com/lancashirecare We will be posting the results of our survey there in Jan 2012.

For more information about safe and sensible amounts of alcohol including your daily limits please go to: http://www.drinkaware.co.uk/tips-and-tools/drink-diary/

All the information collected in this survey is anonymous data so your identity will be protected.

*
1. Are you ?

Are you ? Male

Female

*
2. Are you ?

Are you ? Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75+

*
3. Are you ?

Are you ? White British

White European

White Irish

Mixed Race

Black/Black British

Asian/Asian British

Chinese/Chinese British

Other

*
4. Do you have a disability? (Definition: The Equality Act: - A person has a disability for the purposes of the Act if he or she has a physical or mental impairment and the impairment has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities).

Do you have a disability? (Definition: The Equality Act: - A person has a disability for the purposes of the Act if he or she has a physical or mental impairment and the impairment has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities). Yes

5. In the past 12 months has your alcohol consumption led you to:

	Never	Once	Occasionally	Regularly	Frequently
Become violent	*In the past 12 months has your alcohol consumption led you to: Become violent Never	Become violent Once	Become violent Occasionally	Become violent Regularly	Become violent Frequently
Contract a sexually transmitted disease’	Contract a sexually transmitted disease’ Never	Contract a sexually transmitted disease’ Once	Contract a sexually transmitted disease’ Occasionally	Contract a sexually transmitted disease’ Regularly	Contract a sexually transmitted disease’ Frequently
Feel lethargic and lazy the day after drinking	Feel lethargic and lazy the day after drinking Never	Feel lethargic and lazy the day after drinking Once	Feel lethargic and lazy the day after drinking Occasionally	Feel lethargic and lazy the day after drinking Regularly	Feel lethargic and lazy the day after drinking Frequently
Spend less time with your children	Spend less time with your children Never	Spend less time with your children Once	Spend less time with your children Occasionally	Spend less time with your children Regularly	Spend less time with your children Frequently
Arrive at work with a hangover	Arrive at work with a hangover Never	Arrive at work with a hangover Once	Arrive at work with a hangover Occasionally	Arrive at work with a hangover Regularly	Arrive at work with a hangover Frequently
Perform poorly at work because of alcohol	Perform poorly at work because of alcohol Never	Perform poorly at work because of alcohol Once	Perform poorly at work because of alcohol Occasionally	Perform poorly at work because of alcohol Regularly	Perform poorly at work because of alcohol Frequently
Take time off work	Take time off work Never	Take time off work Once	Take time off work Occasionally	Take time off work Regularly	Take time off work Frequently
Have an accident at work/home	Have an accident at work/home Never	Have an accident at work/home Once	Have an accident at work/home Occasionally	Have an accident at work/home Regularly	Have an accident at work/home Frequently
Have an accident as a result of a prescription drug/alcohol reaction	Have an accident as a result of a prescription drug/alcohol reaction Never	Have an accident as a result of a prescription drug/alcohol reaction Once	Have an accident as a result of a prescription drug/alcohol reaction Occasionally	Have an accident as a result of a prescription drug/alcohol reaction Regularly	Have an accident as a result of a prescription drug/alcohol reaction Frequently
Lose your job	Lose your job Never	Lose your job Once	Lose your job Occasionally	Lose your job Regularly	Lose your job Frequently
Drive whilst over the limit	Drive whilst over the limit Never	Drive whilst over the limit Once	Drive whilst over the limit Occasionally	Drive whilst over the limit Regularly	Drive whilst over the limit Frequently
Be charged with a drink driving offence	Be charged with a drink driving offence Never	Be charged with a drink driving offence Once	Be charged with a drink driving offence Occasionally	Be charged with a drink driving offence Regularly	Be charged with a drink driving offence Frequently
Be charged with a civil or criminal offence	Be charged with a civil or criminal offence Never	Be charged with a civil or criminal offence Once	Be charged with a civil or criminal offence Occasionally	Be charged with a civil or criminal offence Regularly	Be charged with a civil or criminal offence Frequently
Argue/separate with a partner/friend	Argue/separate with a partner/friend Never	Argue/separate with a partner/friend Once	Argue/separate with a partner/friend Occasionally	Argue/separate with a partner/friend Regularly	Argue/separate with a partner/friend Frequently
Lose custody of your children	Lose custody of your children Never	Lose custody of your children Once	Lose custody of your children Occasionally	Lose custody of your children Regularly	Lose custody of your children Frequently
Have an accidental fire in your home/or near miss	Have an accidental fire in your home/or near miss Never	Have an accidental fire in your home/or near miss Once	Have an accidental fire in your home/or near miss Occasionally	Have an accidental fire in your home/or near miss Regularly	Have an accidental fire in your home/or near miss Frequently
Become pregnant	Become pregnant Never	Become pregnant Once	Become pregnant Occasionally	Become pregnant Regularly	Become pregnant Frequently
Wake up somewhere and not know how you got there	Wake up somewhere and not know how you got there Never	Wake up somewhere and not know how you got there Once	Wake up somewhere and not know how you got there Occasionally	Wake up somewhere and not know how you got there Regularly	Wake up somewhere and not know how you got there Frequently

6. What sort of effect do you think that drinking more than recommended daily amounts of alcohol has on the following

	Positive	Negative	Not sure
Maintain a healthy weight	*What sort of effect do you think that drinking more than recommended daily amounts of alcohol has on the following Maintain a healthy weight Positive	Maintain a healthy weight Negative	Maintain a healthy weight Not sure
Healthy appearance	Healthy appearance Positive	Healthy appearance Negative	Healthy appearance Not sure
Health risk to an unborn child	Health risk to an unborn child Positive	Health risk to an unborn child Negative	Health risk to an unborn child Not sure
Educational attainment for children	Educational attainment for children Positive	Educational attainment for children Negative	Educational attainment for children Not sure
Depression	Depression Positive	Depression Negative	Depression Not sure
Anxiety	Anxiety Positive	Anxiety Negative	Anxiety Not sure
Complexion	Complexion Positive	Complexion Negative	Complexion Not sure
Mental alertness	Mental alertness Positive	Mental alertness Negative	Mental alertness Not sure
Intelligence	Intelligence Positive	Intelligence Negative	Intelligence Not sure
Motor skills	Motor skills Positive	Motor skills Negative	Motor skills Not sure
Relaxation	Relaxation Positive	Relaxation Negative	Relaxation Not sure
Ability to drive a motor vehicle	Ability to drive a motor vehicle Positive	Ability to drive a motor vehicle Negative	Ability to drive a motor vehicle Not sure
Violent behavoir	Violent behavoir Positive	Violent behavoir Negative	Violent behavoir Not sure
Domestic violence	Domestic violence Positive	Domestic violence Negative	Domestic violence Not sure
Life expectancy	Life expectancy Positive	Life expectancy Negative	Life expectancy Not sure
Risk of cancer	Risk of cancer Positive	Risk of cancer Negative	Risk of cancer Not sure
Fire in the home	Fire in the home Positive	Fire in the home Negative	Fire in the home Not sure

7. What would be a "drink problem" to you

What would be a "drink problem" to you

8. On average, how regularly do you drink alcohol

On average, how regularly do you drink alcohol Never

Monthly or less

Once or twice a week

Three or four days a week

Daily or nearly

9. How many of the following types of drinks do you consume on average when you drink alcohol

	Monday-thursday	Friday-Sunday
Standard glasses of wine 175ml	How many of the following types of drinks do you consume on average when you drink alcohol Standard glasses of wine 175ml Monday-thursday	Friday-Sunday
Large glass of wine	Large glass of wine Monday-thursday	Friday-Sunday
Bottle of wine	Bottle of wine Monday-thursday	Friday-Sunday
Pints of non alcoholic beer/cider	Pints of non alcoholic beer/cider Monday-thursday	Friday-Sunday
Pints of low alcoholic beer/cider	Pints of low alcoholic beer/cider Monday-thursday	Friday-Sunday
Pints of normal strength beer/lager/cider/bitter	Pints of normal strength beer/lager/cider/bitter Monday-thursday	Friday-Sunday
Pints of strong beer/lager/cider/bitter	Pints of strong beer/lager/cider/bitter Monday-thursday	Friday-Sunday
Bottles of alcopop	Bottles of alcopop Monday-thursday	Friday-Sunday
Can of regular strength lager/bitter/cider	Can of regular strength lager/bitter/cider Monday-thursday	Friday-Sunday
Can of strong lager/bitter/cider	Can of strong lager/bitter/cider Monday-thursday	Friday-Sunday
Bottle of regular strength lager/ bitter/ cider	Bottle of regular strength lager/ bitter/ cider Monday-thursday	Friday-Sunday
Bottle of strong lager /bitter/cider	Bottle of strong lager /bitter/cider Monday-thursday	Friday-Sunday
Single measure of spirits	Single measure of spirits Monday-thursday	Friday-Sunday
Single glasses of sherry/port/martini	Single glasses of sherry/port/martini Monday-thursday	Friday-Sunday

10. Normally, where do you get the alcohol you drink from? please tick all that apply

Normally, where do you get the alcohol you drink from? please tick all that apply Pubs /bars / clubs

Restaurants

Off licences

Corner shops

Supermarkets

Other people(parents)

Other people (friends)

Other people (strangers)

Bought abroad

Mail order

11. Is the social cost of alcohol too high?

Is the social cost of alcohol too high?

*
12. What is the first part of your postcode ?

What is the first part of your postcode ? BB1

BB10

BB11

BB12

BB18

BB2

BB3

BB4

BB5

BB6

BB7

BB8

BB9

BD23

BL0

BL6

BL7

BL8

BL9

FY1

FY2

FY3

FY4

FY5

FY6

FY7

FY8

L31

L33

L37

L39

L40

LA1

LA2

LA3

LA4

LA5

LA6

LA7

OL12

OL13

OL14

Outside Lancashire

PR1

PR2

PR25

PR26

PR3

PR4

PR5

PR6

PR7

PR8

PR9

WA11

WN5

WN6

WN8

*
13. What is your annual pre tax income (or household income if your partner works)

What is your annual pre tax income (or household income if your partner works) Under £4000

£4000 -£7999

£8000 -£16999

£17000-£24999

£25000 -£34999

£35000 -£41999

£42000 -£49999

£50000- £74999

£75000-£99999

£100000+

Whats the DamageExit this survey

What's the Damage

*1. Are you ?

*2. Are you ?

*3. Are you ?

*4. Do you have a disability? (Definition: The Equality Act: - A person has a disability for the purposes of the Act if he or she has a physical or mental impairment and the impairment has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities).