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. 

Question Title

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

Question Title

* 2. What is your birthdate

Date

Question Title

* 3. Zip code

Question Title

* 4. I am a member of Bridge the City.

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 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.

Question Title

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

Question Title

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

0 of 19 answered
 

T