* 1. In the last 12 months have you used alcohol or other drugs?

* 2. If yes, which substances have you used?

* 3. Alcohol

* 4. Cannabis

* 5. Tobacco

* 6. Crystal Methamphetamine (Ice)

* 7. Heroin/Opium/Poppy products

* 8. Ecstasy/MDMA

* 9. Speed

* 10. Energy drinks

* 11. Valium

* 12. Codeine

* 13. Benzodiazepine

* 14. Rohypnol

* 15. OxyContin

* 16. Pseudoephedrine

* 17. Happy herb products

* 18. Steroids

* 19. Methadone/Suboxone/Subutex

* 20. Mushrooms

* 21. Amyl Nitrate

* 22. Other pharmaceuticals

* 23. Your Postcode?

* 24. What is your preferred method of use?

* 25. Have you had any negative effects as a result of your use?

* 26. If yes, please circle or tick as many as applicable

* 27. Have you had any positive effects from your use?

* 28. If yes, please tick as many as applicable 

* 29. Are there any alcohol or drug issues in the Huon Valley that you would like to see addressed?

* 30. How should it be addressed? Tick as many as applicable.

* 31. Your Age?

* 32. Your gender?

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