Relative Substance Abuse Survey

The purpose of this questionnaire is to assess substance use in Escambia, Santa Rosa, and Okaloosa counties among residents ages 13-19. Your participation and the information you provide will help determine the need for substance abuse programs for youth.

This survey is meant to be completed by relatives which include, grandparents, aunts, uncles, brothers, sisters, nieces, nephews, and cousins.

In this survey, the word “Substances” refers to illegal drugs, prescription medications (not prescribed to self), and alcohol.

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* 1. Have you had a relative between the age of 13-19 struggle with substance abuse?

Yes

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* 2. What is your relationship with this relative? You are the…

Grandparent

Aunt

Uncle

Brother

Sister

Cousin

Other (please specify)

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* 3. In 2022, which county did this relative reside in?

Escambia County

Santa Rosa County

Okaloosa County

Other

N/A

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* 4. How old was your relative when they first began struggling with substance abuse?

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* 5. Is your relative currently struggling with substance abuse?

Yes

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* 6. If you answered “no” to question 5, please explain by selecting one of the following:

My relative went to or is currently in a drug rehab

My relative is a member of a 12-step program

My relative is deceased as a result of their substance abuse

My relative is deceased due to other causes NOT related to substance abuse

Other

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* 7. How old is this relative today?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 8. To your knowledge, what substances has your relative used?

Marijuana

Alcohol

Cocaine

Oxycontin or Percocet (not prescribed to you)

Adderall or Ritalin (not prescribed to you)

Acid or Shrooms

Fentanyl

Other

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* 9. Do you feel that it is easy for adolescents to access substances at school or in the community?

Yes

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* 10. Are there organizations within the community where your family can or has accessed help for a relative who struggled or is struggling with substance abuse?

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* 11. In the past 12 months, have you or anyone in the family talked about Fentanyl with a relative who struggled or is struggling with substance abuse?

Yes

Unsure

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* 12. Do you feel that Fentanyl Strips should be legalized in the state of Florida?

Yes

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* 13. Does the relative who struggled or is struggling with substance abuse have access to Narcon in their home?

Yes

Unsure

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* 14. Do you feel that our community needs more resources to assist with adolescent substance abuse?

Yes

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* 15. Do you feel that adolescents ages 13-17, struggling with DAILY substance abuse, would benefit more from:

Outpatient substance abuse services

Inpatient substance abuse services