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Addiction Treatment Survey
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1.
Do you know someone who has a drug or alcohol addiction problem?
(Required.)
Yes
No
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2.
What is their relation to you?
(Required.)
Son or Daughter
Brother or Sister
Father or Mother
Spouse or Significant Other
Other Family Member
Friend or Colleague
Myself
Other (please specify)
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3.
What is the hardest part of helping someone to get help for their addiction?
(Required.)
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4.
What help would you need to overcome that?
(Required.)
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5.
What type of information would be the most helpful to have about addiction?
(Required.)
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6.
Do you think that addiction is a disease?
(Required.)
Yes
No
Unsure (please specify)
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7.
Do you think addiction can be overcome?
(Required.)
Yes
No
Unsure (please specify)
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8.
What do you think is the best type of addiction treatment?
(Required.)
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9.
What do you think is the most ineffective type of addiction treatment?
(Required.)
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10.
How do you feel about addiction treatment programs?
(Required.)
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11.
What do you dislike about addiction treatment programs?
(Required.)
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12.
What are your thoughts about addiction treatment programs using drugs such as suboxone or methadone?
(Required.)
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13.
How could addiction treatment programs improve?
(Required.)
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14.
What type of information would be the most helpful to have about addiction treatment?
(Required.)
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15.
What is your gender?
(Required.)
Female
Male
Other (specify)
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16.
What is your age
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
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17.
Which of the following best describes your current occupation?
(Required.)
Life, Physical, and Social Science Occupations
Healthcare Support Occupations
Management Occupations
Protective Service Occupations
Architecture and Engineering Occupations
Construction and Extraction Occupations
Food Preparation and Serving Related Occupations
Computer and Mathematical Occupations
Personal Care and Service Occupations
Education, Training, and Library Occupations
Arts, Design, Entertainment, Sports, and Media Occupations
Legal Occupations
Installation, Maintenance, and Repair Occupations
Community and Social Service Occupations
Office and Administrative Support Occupations
Production Occupations
Building and Grounds Cleaning and Maintenance Occupations
Farming, Fishing, and Forestry Occupations
Sales and Related Occupations
Business and Financial Operations Occupations
Healthcare Practitioners and Technical Occupations
Transportation and Materials Moving Occupations
Other (please specify)
18.
If you would like someone to contact you for help with addiction treatment, please leave your name and contact information.