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Instructions

This form examines your opinions and thoughts about addictive substances such as alcohol, cocaine, marijuana, tobacco, and opioids.  Examples of opioids include heroin, fentanyl, oxycodone, hydrocodone, codeine, morphine.  Street names include “Hydro, Oxy, Norco, Vikes, Demmies, and Percs.”  Opioids are sometimes prescribed by a doctor for medical treatment.  Signs of addiction include using opioids to get high or feeling as if you need to use the drug even when its use is harming you or others.

The information you provide will help us understand the value of these types of events and what changes may be helpful to better achieve meeting objectives. 

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* 1. What are your first and last name initials?

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* 2. What is your birthdate

Date

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* 3. Zip code

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* 4. I am a member of Athens Seventh-Day Adventist Church.

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* 5. I have personally struggled with opioid use disorder (addiction to opioids).

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* 6. I have a family member who has struggled with opioid use disorder (addiction to opioids).

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* 7. I have a family member who has struggled with other substance use disorders (e.g., addiction to marijuana, cocaine, alcohol, and other substances).

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* 8. This event was the first time I became aware of the need to address opioid use disorder (addiction to opioids).

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* 9. Learning information about opioids is important to me.

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* 10. Learning new skills to address issues related to substance use disorder (addiction to substances such as alcohol, marijuana, cocaine and opioids) is helpful.

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* 11. Reducing false beliefs about substance use disorder (addiction to substances such as alcohol, marijuana, cocaine and opioids) helps improve treatment and recovery outcomes.

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* 12. A house of worship is a good place to seek help for addiction to any drug.

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* 13. People struggling with opioid use disorder (addiction to opioids) cannot be helped by this house of worship.

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* 14.  I am reluctant to assist people struggling with opioid use disorder (addiction to opioids).

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* 15. I am reluctant to assist people struggling with substance use disorder (addiction to substances such as alcohol, marijuana, cocaine and opioids).

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* 16. I know how to assist someone experiencing an opioid overdose.

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* 17. I have information on treatment resources for substance use disorder (addiction to substances such as alcohol, marijuana, cocaine and opioids) that I can share with individuals who need them.

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* 18. I am knowledgeable of the signs and symptoms of substance use disorder (addiction to substances such as alcohol, marijuana, cocaine and opioids).

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* 19. I am knowledgeable of the signs and symptoms of opioid use disorder (addiction to opioids).

0 of 19 answered
 

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