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* 1. School District:

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* 2. Choose the date below that you are taking this survey:

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* 3. How old are you?

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* 4. Are you male or female?

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* 5. What is your ethnic background?

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* 6. How many times have you tried each of the drugs below in your lifetime?

  0 times 1-10 times 11-20 times 20-50 times more than 50 times
Tobacco
Alcohol
Marijuana (Weed)
Cocaine (Crack)
Hallucinogens (LSD, Acid, Mushrooms)
Stimulants (Speed, Meth)
Inhalants (Rush, Nitrous)
Non-prescribed prescription/other medicines
Other (Depressants, PCP, Steroids, Heroin, etc)

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* 7. How many times have you used each of the drugs below in the last month (30 days)?

  0 times 1-10 times 11-20 times 20-50 times more than 50 times
Tobacco
Alcohol
Marijuana (Weed)
Cocaine (Crack)
Hallucinogens (LSD, Acid, Mushrooms)
Stimulants (Speed, Meth)
Inhalants (Rush, Nitrous)
Non-prescribed prescription/other medicines
Other (Depressants, PCP, Steroids, Heroin, etc)

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* 8. Which of the following is not an effective communication skill?

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* 9. An open mind means you are...

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* 10. What percent of students use LSD weekly?

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* 11. What is a self-fulfilling prophecy?

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* 12. Which of the following is NOT a myth of drug use?

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* 13. "Reinterpretation" of drug use consequences means...

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* 14. Difficulty concentrating, urges, sometimes sweating, irritability and restlessness are signs of what?

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* 15. Why might a person in a family affected by drug use feel that he or she must overachieve?

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* 16. What is the best thing to do to support someone who has a drug problem?

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* 17. Which of the following areas of your life may suffer due to marijuana abuse?

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* 18. In terms of damage to the lining of your lungs, two joints are equivalent to how many cigarettes?

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* 19. Which of the following is a good way to deal with tobacco use withdrawal symptoms?

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* 20. What is the third leading cause of preventable death?

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* 21. How many known or suspected cancer-causing substances have been found in tobacco smoke?

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* 22. What does "COPE" stand for?

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* 23. Does drug use cause stress?

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* 24. Laughing at a funeral is an example of...

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* 25. What are the consequences of having negative thoughts?

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* 26. Does drug use lead to negative thinking?

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* 27. What does it mean to have a radical view?

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* 28. A traditional view of gun control would be...

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* 29. What is brainstorming?

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* 30. How likely is it that you will use the following drugs in the next year (12 months)?

  definitely not probably not a little likely somewhat likely very likely
Tobacco
Alcohol
Marijuana (Weed)
Cocaine (Crack)
Hallucinogens (LSD, Acid, Mushrooms)
Stimulants (Speed, Meth)
Inhalants (Rush, Nitrous)
Non-prescribed prescription/other medicines
Other (Depressants, PCP, Steroids, Heroin, etc)

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