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LIFETIME SUBSTANCE ABUSE

This part of the interview asks about your use of alcohol and drugs over your whole life, including now. It is important for us to get accurate information. In order to do this, please think carefully before answering the following questions. Remember, your answers are completely confidential.

F1. Have you ever smoked more than 10 cigarettes in a single day?

YES 1

NO 2

F2. Have you ever tried sedatives, including barbiturates and sleeping pills? Sedatives are sometimes called "downers." People sometimes take sedatives to help them go to sleep or to stay calm during the day. Examples include butisol, seconal, and phenobarbital.

READ REFERENCE LIST IF NECESSARY:

BARBITURATE RESTORIL

BUTISOL HALCION

AMYTAL AMOBARBITAL

MEBARAL PHENOBARBITAL

PLACIDYL METHAQUALONE (Including

NOLUDAR SOPOR, QUAALUDE)

NEMBUTAL CHLORAL HYDRATE

SECONAL PENTOBARBITAL

TUINAL SECOBARBITAL

DALMANE

YES 1

NO 2

F3. People sometimes take amphetamines and other stimulants to help them lose weight, stay awake or to raise their spirits. Amphetamines are also called "uppers" or "speed." Have you ever tried amphetamines or other stimulants? Examples include benzedrine, ritalin, and methamphetamine.

READ REFERENCE LIST IF NECESSARY:

DESEDRINE ("DEXIES") FASTIN

DEXAMYL PONDOMIN

ESKATROL SANOREX

BENZEDRINE ("BENNIES") MAZANOR

BIPHETAMINE RITALIN

DESOXYN CYLERT

TENUATE DEXTROAMPHETAMINE

TEPANIL METHEDRINE

DIDREX METHAMPHETAMINE

PLEGINE (SPEED OR ICE OR

PREDULIN CRANK)

IONAMIN OBEDRIN-L.A.

YES 1

NO 2

F4. Have you ever tried analgesics, which are taken as pain killers, although people sometimes use them for other reasons. Examples include darvon, percodan, and codeine.

READ REFERENCE LIST IF NECESSARY:

DARVON TALWIN

DOLENE TALWIN NX

SK-65 TALACEN

WYGESIC PROPOXYPHENE

LEVO-DROMORAN CODEINE

PERCODAN ANILERIDINE

DEMOROL MORPHINE

DILAUDID METHADONE

TYLENOL III STADOL

PHENAPHEN WITH CODEINE

YES 1

NO 2

F5. Now I'm going to ask you about tranquilizers. Have you ever tried or taken tranquilizers? Examples include valium, xanax, and diazepam.

READ REFERENCE LIST IF NECESSARY:

VALIUM MILTOWN

LIBRIUM EQUANIL

LIMBRITROL DEPROL

MENRIUM VISTARIL

SERAX ATARX

TRANXENE DURRAX

ATIVAN DIAZEPAM

CENTRAX SK-LYGEN

XANAX MEPROBAMATE

PAXIPAM ROHYPNOL ("ROOFIES")

BUSPAR

YES 1

NO 2

F6. Inhalants are sometimes sniffed, inhaled or "huffed" to get people high or make them feel better. Have you ever tried anything like this? Examples include freon, spray paints, and nitrous oxide.

READ REFERENCE LIST IF NECESSARY:

FREON

SPRAY PAINTS

OTHER AEROSOL SPRAYS

SHOESHINE LIQUID, GLUE OR OTHER PAINT SOLVENTS

AMYLNITRITE ("POPPERS"), LOCKER ODORIZER ("RUSH")

HALOTHANE, EITHER OR OTHER ANESTHETICS

NITROUS OXIDE ("WHIPPETS")

CORRECTION FLUIDS, DEGREASERS, CLEANING FLUIDS

GASOLINE

YES 1

NO 2

F7. Have you ever tried marijuana or hashish?

YES 1

NO 2

F8. Have you ever tried powder cocaine?

YES 1

NO 2

F9. Have you ever tried crack cocaine?

YES 1

NO 2

F10. Have you ever tried hallucinogens (LSD, PCP/angel dust, peyote/mushrooms, Ketamine/Special K)?

YES 1

NO 2

F11. Have you ever tried heroin?

YES 1

NO 2

F12. How many times (if any) have you chewed tobacco? By times, we mean separate occasions on which you were under the influence of chewed tobacco.

Would you say...

None, 1

1-2 times, 2

3-5 times, 3

6-9 times, 4

10-19 times, 5

20-39 times, or 6

40 or more times 7

F13. How many times (if any) have you injected drugs?

READ CATEGORIES IF NECESSARY

NONE 1

1-2 TIMES 2

3-5 TIMES 3

6-9 TIMES 4

10-19 TIMES 5

20-39 TIMES 6

40 OR MORE TIMES 7

F14. How many times (if any) have you used Rohypnol (roofies)?

READ CATEGORIES IF NECESSARY

NONE 1

1-2 TIMES 2

3-5 TIMES 3

6-9 TIMES 4

10-19 TIMES 5

20-39 TIMES 6

40 OR MORE TIMES 7

F15. How many times (if any) have you used designer drugs like "ecstacy" or MDMA?

READ CATEGORIES IF NECESSARY

NONE 1

1-2 TIMES 2

3-5 TIMES 3

6-9 TIMES 4

10-19 TIMES 5

20-39 TIMES 6

40 OR MORE TIMES 7

F16. How many times (if any) have you used ketamine (special K)?

READ CATEGORIES IF NECESSARY

NONE 1

1-2 TIMES 2

3-5 TIMES 3

6-9 TIMES 4

10-19 TIMES 5

20-39 TIMES 6

40 OR MORE TIMES 7

Next are a few questions about use of alcoholic beverages.

F17. In your lifetime, have you ever had more than just a sip of beer, wine or liquor?

YES 01

NO (GO TO INTERVIEWER

CHECKPOINT B) 02

ALCOHOL

F17_FU. About how old were you the very first time you had more than just a sip of beer, wine or liquor?

|___|___|

YEARS OLD

F17a. In any one year period of your entire life, did you have at least 12 drinks of any kind of alcoholic beverage?

YES (CIRCLE "A. ALCOHOL" ON SUBSTANCE LIST CARD F2) 1

NO (GO TO INTERVIEWER

CHECKPOINT B) 2

F17b. Think about the past 12 months. What is the largest number of drinks you had on any single day during that period?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

|___|___|___|

# OF DRINKS

ZERO DRINKS (GO TO F17h) 0

INTERVIEWER CHECKPOINT A

SEE F17b 1. 20 OR MORE DRINKS IN f17b è NEXT PAGE, f17c

2. 10-19 DRINKS IN f17b è NEXT PAGE, f17d

3. 5- 9 DRINKS IN f17b è NEXT PAGE, f17e

4. 3- 4 DRINKS IN f17b è NEXT PAGE, f17f

5. 1- 2 DRINKS IN f17b è NEXT PAGE, f17g

F17c. How often did you have twenty or more drinks in a single day during the past twelve months? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO F17h) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17d. How often did you have between ten and nineteen drinks in a single day during the past 12 months? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO F17h) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17e. How often did you have between five and nine drinks in a single day during the past 12 months? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO F17h) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17f. How often did you have three or four drinks in a single day during the past 12 months? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO F17h) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17g. How often did you have one or two drinks in a single day during the past 12 months? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO F17h) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17h. Was there ever a time in your life when you could have twenty-four drinks in a single day without it affecting your ability to function normally?

YES 1

NO 2

F17i. Has there ever been a period in your life when you drank more than you did during the past 12 months?

YES (GO TO F17k) 1

NO 2

F17j. How old were you when you first began to drink as much as you did during the past 12 months?

|___|___|

YEARS OLD

INTERVIEWER: GO TO CHECKPOINT B

F17k. Think about the period in your life when you were drinking most. How old were you when you first began that period?

|___|___|

YEARS OLD

F17l. During that period when you were drinking most, how often did you have twenty-four or more drinks in a single day? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO INTERVIEWER

CHECKPOINT B) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, pror 8

never 9

F17m. How often did you have between twelve and twenty-three drinks in a single day (during that period when you were drinking most)? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO INTERVIEWER

CHECKPOINT B) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17n. How often did you have between five and eleven drinks in a single day (during that period when you were drinking most)? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO

INTERVIEWER CHECKPOINT B) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

F17o. How often did you have between one and four drinks in a single day (during that period when you were drinking most)? Would you say...

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST:

EQUIVALENCE LIST:

1 DRINK - 1 CAN OR BOTTLE OF BEER

- 1 12 OZ. BOTTLE WINE COOLER

- 1 4 OZ. GLASS OF WINE

- 1 SHOT OF LIQUOR

5 DRINKS - 5 CANS OR BOTTLES OF BEER

- 3/4 OF A BOTTLE OF WINE

- 1/2 OF A PINT OF LIQUOR

- 1/5 OF A LITRE BOTTLE OF LIQUOR

10 DRINKS - 10 CANS OR BOTTLES OF BEER

- 1 1/2 BOTTLES OF WINE

- 1/3 GALLON OF WINE

- 1 PINT OF LIQUOR

- 1/2 OF A LITRE BOTTLE OF LIQUOR

20 DRINKS - 20 CANS OR BOTTLES OF BEER

- 3 REGULAR SIZE BOTTLES OF WINE

- 1 LITRE BOTTLE OF LIQUOR

Nearly every day, (GO TO

INTERVIEWER CHECKPOINT B) 1

3-4 times a week, 2

1-2 times a week, 3

1-3 times a month, 4

7-11 times in a year, 5

3-6 times in year, 6

2 times in year, 7

1 time in year, or 8

never 9

|___| 2. ALL OTHERS è GOTO INTERVIEWER CHECKPOINT L PAGE 22

CIGARETTES

Earlier, you told me that you had smoked more than 10 cigarettes in a day at some point in your life.

F18. How old were you the first time you smoked a cigarette?

|___|___|

YEARS OLD

F18a. How old were you when you first started to smoke more than 10 cigarettes a day?

|___|___|

YEARS OLD

F18b. Do you smoke now?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT C) 2

F18c. How many cigarettes a day do you smoke?

PROBE: READ CATEGORIES IF NECESSARY

LESS THAN OR EQUAL TO 10 1

11-20 2

21-30 3

31 OR MORE 4

INTERVIEWER CHECKPOINT C

SEE REFERENCE CARD, "SCREENERS" F2-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F2-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F2-F11 SERIES IS:

|___| F2 è TURN TO F19

|___| F3 è TURN TO F20

|___| F4 è TURN TO F21

|___| F5 è TURN TO F22

|___| F6 è TURN TO F23

|___| F7 è TURN TO F24

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS, GOTO INTERVIEWER CHECKPOINT L

SEDATIVES

F19. Earlier, I mentioned sedatives, and you told me that you tried at least one of them. There is a very important point about the next questions. We are interested in whether you have used them without a doctor telling you to take them. Have you ever used a sedative on your own (that is, either without a doctor’s prescription or in greater amounts, or more often than prescribed, or for a reason other than a doctor said you should take them, such as for kicks, to get high, to feel good, or curiosity about the pill’s effect)?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

BARBITUATE RESTORIL

BUTISOL HALCION

AMYTAL AMOBARBITOL

MEBARAL PHENIBARBITAL

PLACIDYL METHAQYALONE (including

NOLUDAR SOPOR, QUAALUDE)

NEMBUTAL CHLORAL HYDRATE

SECONAL PENTOBARBITAL

TUINAL SECOBARBITAL

DALMANE

YES (GO TO F19c) 1

NO 2

F19a. Have you ever used a sedative that a doctor prescribed for you?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

BARBITUATE RESTORIL

BUTISOL HALCION

AMYTAL AMOBARBITOL

MEBARAL PHENIBARBITAL

PLACIDYL METHAQYALONE (including

NOLUDAR SOPOR, QUAALUDE)

NEMBUTAL CHLORAL HYDRATE

SECONAL PENTOBARBITAL

TUINAL SECOBARBITAL

DALMANE

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT D) 2

F19b. Was your use ever so regular that you could not stop or felt dependent?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

BARBITUATE RESTORIL

BUTISOL HALCION

AMYTAL AMOBARBITOL

MEBARAL PHENIBARBITAL

PLACIDYL METHAQYALONE (including

NOLUDAR SOPOR, QUAALUDE)

NEMBUTAL CHLORAL HYDRATE

SECONAL PENTOBARBITAL

TUINAL SECOBARBITAL

DALMANE

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT D) 2

F19c. How old were you the first time you took a sedative (for any nonmedical reason)?

|___|___|

YEARS OLD

F19d. Altogether, about how many times in your life have you taken sedatives (for any nonmedical reason)? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "B. SEDATIVES" ON SUBSTANCE LIST CARD F2) 3

11 to 49 times, (CIRCLE "B. SEDATIVES" ON SUBSTANCE LIST CARD F2) 4

50 to 99 times, (CIRCLE "B. SEDATIVES" ON SUBSTANCE LIST CARD F2) 5

100 to 199 times, or (CIRCLE "B. SEDATIVES" ON SUBSTANCE LIST CARD F2) 6

200 or more times (CIRCLE "B. SEDATIVES" ON SUBSTANCE LIST CARD F2) 7

F19e. When was the last time you took any sedative (for nonmedical reasons)? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago

(GO TO F19h) 4

F19f. About how often in the past 12 months did you take any sedative (for nonmedical reasons)? Would you say...

Daily, 1

almost daily or 3 times a week, 2

several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F19g. About how often have you done this in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT D) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT D) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT D) 4

not at all 5

F19h. How old were you the last time?

|___|___|

years old

INTERVIEWER CHECKPOINT D

SEE REFERENCE CARD, "SCREENERS" F3-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F3-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F3-F11 SERIES IS:

|___| F3 è TURN TO F20

|___| F4 è TURN TO F21

|___| F5 è TURN TO F22

|___| F6 è TURN TO F23

|___| F7 è TURN TO F24

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS, TURN TO INTERVIEWER CHECKPOINT L

AMPHETAMINES

F20. Earlier, I mentioned amphetamines and other stimulants, and you told me that you tried least one of them. There is a very important point about the next questions. We are interested in whether you have used them without a doctor telling you to take them. Have you ever used a stimulant on your own, (that is, either without a doctor's prescription or in greater amounts or more often than prescribed or for a reason other than a doctor said you should use them, such as for kicks, to get high, to feel good, or curiosity about the pill’s effect)?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

DESEDRINE ("DEXIES") FASTIN

DEXAMYL PONDOMIN

ESKATROL SANOREX

BENZEDRINE ("BENNIES") MAZANOR

BIPHETAMINE RITALIN

DESOXYN CYLERT

TENUATE DEXTROAMPHETAMINE

TEPANIL METHEDRINE

DIDREX METHAMPHETAMINE

PLEGINE (SPEED OR ICE OR

PREDULIN CRANK)

IONAMIN OBEDRIN-L.A.

YES (GO TO F20c) 1

NO 2

F20a. Have you ever used a stimulant that a doctor prescribed for you?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT E) 2

F20b. Was your use ever so regular that you could not stop or felt dependent?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT E) 2

F20c. How old were you the first time you took an amphetamine or other stimulant (for any nonmedical reason)?

|___|___|

YEARS OLD

F20d. Altogether, about how many times in your life have you taken amphetamines or other stimulants (for any nonmedical reason)? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "D. SEDATIVES" ON CARD F2) 3

11 to 49 times, (CIRCLE "D. SEDATIVES" ON CARD F2) 4

50 to 99 times, (CIRCLE "D. SEDATIVES" ON CARD F2) 5

100 to 199 times, or (CIRCLE "D. SEDATIVES" ON CARD F2) 6

200 or more times (CIRCLE "D. SEDATIVES" ON CARD F2) 7

F20e. When was the last time you took any amphetamine or other stimulant (for nonmedical reasons? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F19h) 4

F20f. About how often in the past 12 months did you take any amphetamine or other stimulant (for nonmedical reasons)? Would you say...

Daily, 1

almost daily or 3 times a week, 2

several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F20g. About how often have you done this in the past month? Would you say...

Daily,, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT E) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT E) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT E) 4

not at all 5

F20h. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT E

SEE REFERENCE CARD, "SCREENERS" F4-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F4-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F4-F11 SERIES IS:

|___| F4 è TURN TO F21

|___| F5 è TURN TO F22

|___| F6 è TURN TO F23

|___| F7 è TURN TO F24

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS [TURN TO INTERVIEWER CHECKPOINT L

ANALGESICS

F21. Earlier, I mentioned analgesics, and you told me that you tried at least one of them. There is a very important point about the next questions. We are interested in whether you have used them without a doctor telling you to take them. Have you ever used an analgesic on your own, (that is, either without a doctor's prescription or in greater amounts or more often than prescribed or for a reason other than a doctor said you should use them such as for kicks, to get high, to feel good, or curiosity about the pill's effect)?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

DARVON TALWIN

DOLENE TALWIN NX

SK-65 TALACEN

WYGESIC PROPOXYPHENE

LEVO-DROMORAN CODEINE

PERCODAN ANILERIDINE

DEMOROL MORPHINE

DILAUDID METHADONE

TYLENOL III STADOL

PHENAPHEN

WITH CODEINE

YES (GO TO F21c) 1

NO 2

F21a. Have you ever used a analgesic that a doctor prescribed for you?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT F) 2

F21b. Was your use ever so regular that you could not stop or felt dependent?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT F) 2

F21c. How old were you the first time you took an analgesic (for any nonmedical reason)?

|___|___|

YEARS OLD

F21d. Altogether, about how many times in your life have you taken analgesics (for any nonmedical reason)? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "D. STIMULANTS" ON CARD F2) 3

11 to 49 times, (CIRCLE "D. STIMULANTS" ON CARD F2) 4

50 to 99 times, (CIRCLE "D. STIMULANTS" ON CARD F2) 5

100 to 199 times, or (CIRCLE "D. STIMULANTS" ON CARD F2) 6

200 or more times (CIRCLE "D. STIMULANTS" ON CARD F2) 7

F21e. When was the last time you took any analgesic (for nonmedical reasons)? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F19h) 4

F21f. About how often in the past 12 months did you take any analgesic (for nonmedical reasons)? Would you say...

Daily, 1

almost daily or 3 times a week, 2

Several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

Every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F21g. About how often have you done this in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT F) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT F) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT F) 4

not at all 5

F21h. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT F

SEE REFERENCE CARD, "SCREENERS" F5-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F5-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F5-F11 SERIES IS:

|___| F5 è TURN TO F22

|___| F6 è TURN TO F23

|___| F7 è TURN TO F24

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS [TURN TO INTERVIEWER CHECKPOINT L

TRANQUILIZERS

F22. Earlier, I mentioned tranquilizers, and you told me that you tried at least one of them. There is a very important point about the next questions. We are interested in whether you have used them without a doctor telling you to take them. Have you ever used a tranquilizer on your own, (that is, either without a doctor's prescription or in greater amounts or more often than prescribed or for a reason other than a doctor said you should use them, such as for kicks, to get high, to feel good, or curiosity about the pill's effect)?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

VALIUM MILTOWN

LIBRIUM EQUANIL

LIMBRITROL DEPROL

MENRIUM VISTARIL

SERAX ATARX

TRANXENE DURRAX

ATIVAN DIAZEPAM

CENTRAX SK-LYGEN

XANAX MEPROBAMATE

PAXIPAM ROHYPNOL ("ROOFIES")

BUSPAR

YES (GO TO F22C) 1

NO 2

F22a. Have you ever used tranquilizers that a doctor prescribed for you?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT G) 2

F22b. Was your use ever so regular that you could not stop or felt dependent?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT G) 2

F22c. How old were you the first time you took a tranquilizer (for any nonmedical reason)?

|___|___|

YEARS OLD

F22d. Altogether, about how many times in your life have you taken tranquilizers (for any nonmedical reason)? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "C. TRANQUILIZERS" ON CARD F2) 3

11 to 49 times, (CIRCLE "C. TRANQUILIZERS" ON CARD F2) 4

50 to 99 times, (CIRCLE "C. TRANQUILIZERS" ON CARD F2) 5

100 to 199 times, or (CIRCLE "C. TRANQUILIZERS" ON CARD F2) 6

200 or more times (CIRCLE "C. TRANQUILIZERS" ON CARD F2) 7

F22e. When was the last time you took any tranquilizer (for nonmedical reasons)? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F22h) 4

F22f. About how often in the past 12 months did you take any tranquilizer (for nonmedical reasons)? Would you say...

Daily, 1

almost daily or 3 times a week, 2

Several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

Every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F22g. About how often have you done this in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT G) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT G) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT G) 4

not at all 5

F21h. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT G

SEE REFERENCE CARD, "SCREENERS" F6-FF11

|___| 1. ONE OR MORE "YES" RESPONSES IN F6-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F6-F11 SERIES IS:

|___| F6 è TURN TO F23

|___| F7 è TURN TO F24

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS è [GOTO INTERVIEWER CHECKPOINT L

INHALANTS

F23. Earlier, I mentioned inhalants, and you told me that you tried at least one of them. How old were you the first time you sniffed or inhaled or ("huffed") an inhalant for kicks or to get high?

PROBE: READ INTERVIEWER REFERENCE LIST IF NECESSARY

INTERVIEWER REFERENCE LIST

FREON

SPRAY PAINTS

OTHER AEROSOL SPRAYS

SHOESHINE LIQUID, GLUE OR OTHER PAINT SOLVENTS

AMYLNITRITE ("POPPERS"), LOCKER ODORIZER ("RUSH")

HALOTHANE, EITHER OR OTHER ANESTHETICS

NITROUS OXIDE ("WHIPPETS")

CORRECTION FLUIDS, DEGREASERS, CLEANING FLUIDS

GASOLINE

|___|___|

YEARS OLD

F23a. About how many times in your life have you used an inhalant to get high or for kicks? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "F. INHALANTS" ON CARD F2) 3

11 to 49 times, (CIRCLE "F. INHALANTS" ON CARD F2) 4

50 to 99 times, (CIRCLE "F. INHALANTS" ON CARD F2) 5

100 to 199 times, or (CIRCLE "F. INHALANTS" ON CARD F2) 6

200 or more times (CIRCLE "F. INHALANTS" ON CARD F2) 7

F23b. When was the last time you used an inhalant (that is, sniffed or inhaled something to get high or for kicks? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F23e) 4

F23c. About how often in the past 12 months did you sniff or inhale any substance to get high or for kicks? Would you say...

Daily 1

almost daily or 3 times a week, 2

several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F23d. About how often have you done this in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT H) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT H) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT H) 4

not at all 5

F23e. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT H

SEE REFERENCE CARD, "SCREENERS" F7-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F7-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F2-F11 SERIES IS:

|___| F7 è TURN TO F24

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS è GOTO INTERVIEWER CHECKPOINT L

MARIJUANA OR HASHISH

F24. Earlier, you told me that you tried marijuana or hashish. How old were you the first time (you tried marijuana or hashish)?

|___|___|

YEARS OLD

200 or more times (CIRCLE "G. MARIJUANA" ON CARD F2) 7

F24b. When was the last time (you used marijuana or hashish)? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F24e) 4

F24c. About how often in the past 12 months have you used marijuana or hashish? Would you say...

Daily, 1

almost daily or 3 times a week 2

several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F24d. About how often have you done this in the past month? Would you say...

Daily, (GO TO INTERVIEWER CHECKPOINT I) 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT I) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT I) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT I) 4

not at all (GO TO INTERVIEWER CHECKPOINT I) 5

F24e. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT I

SEE REFERENCE CARD, "SCREENERS" F8-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F8-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F8-F11 SERIES IS:

|___| F8 è TURN TO F25

|___| F9 è TURN TO F25

|___| F10 è TURN TO F26

|___| F11 è TURN TO F26

|___| 2. ALL OTHERS è GO TO INTERVIEWER CHECKPOINT L

POWDER COCAINE OR CRACK

F25. Earlier, you told me that you have tried powder cocaine or crack. How old were you the first time (you used cocaine, crack, free base or coca paste)?

|___|___|

YEARS OLD

F25a. About how many times have you used powder cocaine, crack, free base or coca paste in your life? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "H. COCAINE" ON CARD F2) 3

11 to 49 times, (CIRCLE "H. COCAINE" ON CARD F2) 4

50 to 99 times, (CIRCLE "H. COCAINE" ON CARD F2) 5

100 to 199 times, or (CIRCLE "H. COCAINE" ON CARD F2) 6

200 or more times (CIRCLE "H. COCAINE" ON CARD F2) 7

F25b. When was the last time (you used cocaine in any form)? Was it in the...

Past month, 1

past six months 2

past year, or 3

more than a year ago (GO TO F25e) 4

F25c. About how often in the past 12 months have you used cocaine? Would you say...

Daily, 1

almost daily or 3 times a week, 2

several times a month (about 25-51

days/year), 3

1-2 times a month, (12-24 days/year) 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F25d. About how often have you used cocaine in any form in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT J) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT J) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT J) 4

not at all 5

F25e. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT J

SEE REFERENCE CARD, "SCREENERS" F10-F11

|___| 1. ONE OR MORE "YES" RESPONSES IN F10-F11

INTERVIEWER QUERY: FIRST "YES" RESPONSE IN F10-F11 SERIES IS:

|___| F10 è TURN TO F26

|___| F11 è TURN TO F27

|___| 2. ALL OTHERS GOTO INTERVIEWER CHECKPOINT L

HALLUCINOGENS

F26. Earlier, you told me that you have tried hallucinogens. How old were you the first time you used a hallucinogen?

|___|___|

YEARS OLD

F26a. About how many times in your life have you used hallucinogens? Would you say...

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "I. HALLUCINOGEN" ON CARD F2) 3

11 to 49 times, (CIRCLE "I. HALLUCINOGEN" ON CARD F2) 4

50 to 99 times, (CIRCLE "I. HALLUCINOGEN" ON CARD F2) 5

100 to 199 times, or (CIRCLE "I. HALLUCINOGEN" ON CARD F2) 6

200 or more times (CIRCLE "I. HALLUCINOGEN" ON CARD F2) 7

F26b. When was the last time you used a hallucinogen? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F26e) 4

F26c. About how often in the past 12 months have you used a hallucinogen? Would you say...

Daily, 1

almost daily or 3 times a week, 2

several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F26d. About how often have you used hallucinogens in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT K) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT K) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT K) 4

not at all 5

F26e. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT K

SEE REFERENCE CARD, "SCREENER" F11

|___| F11 è TURN TO F27

OTHERWISE GOTO INTERVIEWER CHECKPOINT L

HEROIN

F27. Earlier, you told me that you have tried heroin. How old were you the first time you used heroin?

|___|___|

years old

F27a. How many times in your life have you used heroin?

1 or 2 times, 1

3 to 5 times, 2

6 to 10 times, (CIRCLE "J. HEROIN" ON CARD F2) 3

11 to 49 times, (CIRCLE "J. HEROIN" ON CARD F2) 4

50 to 99 times, (CIRCLE "J. HEROIN" ON CARD F2) 5

100 to 199 times, or (CIRCLE "J. HEROIN" ON CARD F2) 6

200 or more times (CIRCLE "J. HEROIN" ON CARD F2) 7

F27b. When was the last time you used heroin? Was it in the...

Past month, 1

past six months, 2

past year, or 3

more than a year ago (GO TO F27e) 4

F27c. About how often in the past 12 months have you used heroin? Would you say...

Daily, 1

almost daily or 3 times a week 2

several times a month (about 25-51

days/year), 3

1-2 times a month (12-24 days/year), 4

every other month or so (6-11

days/year), 5

3-5 times a year, or 6

1-2 times a year 7

F27d. About how often have you done this in the past month? Would you say...

Daily, 1

almost daily or 3 times a week, (GO TO INTERVIEWER CHECKPOINT L) 2

1-2 times a week, (GO TO INTERVIEWER CHECKPOINT L) 3

1-2 times a month, or (GO TO INTERVIEWER CHECKPOINT L) 4

not at all 5

F27e. How old were you the last time?

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT L

SEE SUBSTANCE LIST, REFERENCE CARD F2

|__| 1. ONE OR MORE SUBSTANCES CIRCLED; GO TO F28

|__| 2. ALL OTHERSèGO TO SECTION CC

F28. In answering the next questions, please think about all of the substances that you told me you have taken. Have you often been under the effects of any of the substances you have mentioned or suffering its after-effects while at work or school or taking care of children?

YES 1

NO (GO TO F29) 2

IF F28=YES: ASK F28a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F28b-d

F28a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F28b.

How old were you the first time this happened because of using (FILL FROM F28a SUBSTANCES)?

PROBE: "This" means often been under the effects of any of the substances you have mentioned or suffering its after-effects while at work or school or taking care of children?

F28c.

When was the last time this happened because of using (FILL FROM F28a SUBSTANCES)?

PROBE: "This" means often been under the effects of any of the substances you have mentioned or suffering its after-effects while at work or school or taking care of children?

F28d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (fill FROM f28a SUBSTANCES)]?

PROBE: "This" means often been under the effects of any of the substances you have mentioned or suffering its after-effects while at work or school or taking care of children?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F29. Has your use of (FILL FROM F28a SUBSTANCES / any of these substances you have mentioned) often kept you from working, going to school, or taking care of children?

YES 1

NO (GO TO F30) 2

IF F29=YES: ASK F29a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F29b-d

F29a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F29b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F29a]?

PROBE: "This" means often kept you from working, going to school, or taking care of children?

F29c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F29a)?

PROBE: "This" means often kept you from working, going to school, or taking care of children?

F29d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (fill WITH APPROPRIATE SUBSTANCE FROM F29a)]?

PROBE: "This" means often kept you from working, going to school, or taking care of children?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F30. Did (FILL WITH POSITIVE RESPONSES FROM F17 AND F2 TO F11 IF POSSIBLE / ANY OF THESE SUBSTANCES YOU HAVE MENTIONED) ever cause you problems with your family, friends, at work or at school?

YES 1

NO (GO TO F31) 2

IF F30=YES: ASK F30a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F30b-d

F30a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances caused these problems?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F30b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F30a)?

PROBE: "This" means any of these substances ever cause you problems with your family, friends, at work or at school?

F30c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F30a)?

PROBE: "This" means any of these substances ever cause you problems with your family, friends, at work or at school?

F30d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F30a)]?

PROBE: "This" means any of these substances ever cause you problems with your family, friends, at work or at school?

F30e.

Did you continue to use (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F30a / any of these substances you have mentioned] after you realized it was causing any of these problems?

PROBE: "This" means any of these substances ever cause you problems with your family, friends, at work or at school?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

YES 1

NO 2

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

Yes 1

No 2

F31. Did your use of (FILL ANY OF THESE SUBSTANCES YOU HAVE MENTIONED) ever cause you to be expelled from school, or to be demoted or fired from work?

YES 1

NO (GO TO F32) 2

IF F31=YES: ASK F31a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F31b-d

F31a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F31b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F31a)?

PROBE: "This" means ever cause you to be expelled from school, or to be demoted or fired from work?

F31c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F31a)?

PROBE: "This" means ever cause you to be expelled from school, or to be demoted or fired from work?

F31d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F31a)]?

PROBE: "This" means ever cause you to be expelled from school, or to be demoted or fired from work?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F32. Have you often been under the effects of [any of the substances you have mentioned] or suffering its after-effects in a situation which increased your chances of getting hurt--like when driving a car or boat, using knives or guns or machinery, crossing against the traffic, climbing or swimming?

YES 1

NO (GO TO F33) 2

IF F32=YES: ASK F32a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F32b-d

F32a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F32b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F32a)?

PROBE: "This" means often been under the effect of any of the substances you have mentioned or suffering its after-effects in a situation which increased your chances of getting hurt – like when driving a car or boat, using knives or guns or machinery, crossing against the traffic, climbing or swimming?

F32c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F32a)?

PROBE: "This" means often been under the effect of any of the substances you have mentioned or suffering its after-effects in a situation which increased your chances of getting hurt – like when driving a car or boat, using knives or guns or machinery, crossing against the traffic, climbing or swimming?

F32d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE FROM F32a)?

PROBE: "This" means often been under the effect of any of the substances you have mentioned or suffering its after-effects in a situation which increased your chances of getting hurt – like when driving a car or boat, using knives or guns or machinery, crossing against the traffic, climbing or swimming?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F33. Did you ever accidentally injure yourself when you have been under the influence of [any of these substances you have mentioned]—like had a bad fall or cut yourself badly, been hurt in a traffic accident, or anything like that?

Yes 1

No (GO TO F34) 2

F33a. Did you continue to use the substance after it caused the accident?

Yes 1

No (GO TO F34) 2

IF F33=YES: ASK F33a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F33b-d

F33a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you continue to use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F33b.

How old were you the first time you continued to use (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F33a) after an accident?

PROBE: "This" means ever accidentally injure yourself when you have been under the influence of any of these substances -- like had a bad fall or cut yourself badly, been hurt in a traffic accident, or anything like that?

F33c.

When was the last time [you continued to use [(FILL WITH APPROPRIATE SUBSTANCE(S) FROM F33a) after an accident]?

PROBE: "This" means ever accidentally injure yourself when you have been under the influence of any of these substances -- like had a bad fall or cut yourself badly, been hurt in a traffic accident, or anything like that?

F33d.

IF MORE THAN A YEAR AGO: How old were you the last time [you continued using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F33a)] after an accident?

PROBE: "This" means ever accidentally injure yourself when you have been under the influence of any of these substances -- like had a bad fall or cut yourself badly, been hurt in a traffic accident, or anything like that?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F34. Have you ever had any health problems as a result of using

any of the substances you have mentioned—such as liver disease, stomach disease, pancreatitis, feet tingling, numbness, memory problems, an accidental overdose, a persistent cough, a seizure or fit, hepatitis, or abscesses?

YES 1

NO (GO TO F35) 2

IF F34=YES: ASK F34a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F34b-d

F34a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances caused these problems?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F34b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F34a)?

PROBE: "This" means ever had any health problems as a result of using any of the substances you have mentioned – such as liver disease, stomach disease, pancreatitis, feet tingling, numbness, memory problems, an accidental overdose, a persistent cough, a seizure or fit, hepatitis, or abscesses?

F34c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F34a)?

PROBE: "This" means ever had any health problems as a result of using any of the substances you have mentioned – such as liver disease, stomach disease, pancreatitis, feet tingling, numbness, memory problems, an accidental overdose, a persistent cough, a seizure or fit, hepatitis, or abscesses?

F34d.

IF MORE THAN A YEAR AGO: How old were you the last time [you continued using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F34a)] after an accident?

PROBE: "This" means ever had any health problems as a result of using any of the substances you have mentioned – such as liver disease, stomach disease, pancreatitis, feet tingling, numbness, memory problems, an accidental overdose, a persistent cough, a seizure or fit, hepatitis, or abscesses?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F35. Have you ever had any emotional or psychological problems from using any of the substances you have mentioned—such as feeling uninterested in things, feeling depressed, suspicious of people, paranoid, or having strange ideas?

YES 1

NO (GO TO INTERVIEWER

CHECKPOINT M) 2

IF F35=YES: ASK F35a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F35b-d

F35a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances caused these problems?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F35b.

How old were you the first time you continued to use (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F35a)?

PROBE: "This" means ever had any emotional or psychological problems from using any of the substances you have mentioned – such as feeling uninterested in things, feeling depressed, suspicious of people, paranoid, or having strange ideas?

F35c.

When was the last time you continued to use (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F35a)?

PROBE: "This" means ever had any emotional or psychological problems from using any of the substances you have mentioned – such as feeling uninterested in things, feeling depressed, suspicious of people, paranoid, or having strange ideas?

F35d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F35a)]?

PROBE: "This" means ever had any emotional or psychological problems from using any of the substances you have mentioned – such as feeling uninterested in things, feeling depressed, suspicious of people, paranoid, or having strange ideas?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

INTERVIEWER CHECKPOINT M

|__| 1. ONE OR MORE MENTIONS IN F34 OR F35, GO TO F36

|__| 2. ALL OTHERSè F37

F36. Did you ever continue to use [any of the substances you have mentioned] after you realized it was causing problems with your physical or mental health?

YES 1

NO (GO TO F37) 2

F36a. CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you continue to use?

ALCOHOL |___|

SEDATIVES |___|

TRANQUILIZERS |___|

STIMULANTS |___|

ANALGESICS |___|

INHALANTS |___|

MARIJUANA |___|

COCAINE |___|

HALLUCINOGENS |___|

HEROIN |___|

F37. Did you ever continue to use any of the substances you have mentioned while taking medicine you knew was dangerous to mix with alcohol or drugs, or when you had a serious health problem that could be made worse by alcohol or drugs?

YES 1

NO (GO TO F38) 2

IF F37=YES: ASK F37a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F37b-d

F37a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you continue using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F37a)?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F37b.

How old were you the first time you continued to use (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F37a) in such a situation?

PROBE: "This" means ever continue to use any of the substances you have mentioned while taking medicine you knew was dangerous to mix with alcohol or drugs, or when you had a serious health problem that could be made worse by alcohol or drugs?

F37c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F37a)?

PROBE: "This" means ever continue to use any of the substances you have mentioned while taking medicine you knew was dangerous to mix with alcohol or drugs, or when you had a serious health problem that could be made worse by alcohol or drugs?

F37d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F37a)?

PROBE: "This" means ever continue to use any of the substances you have mentioned while taking medicine you knew was dangerous to mix with alcohol or drugs, or when you had a serious health problem that could be made worse by alcohol or drugs?

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F38. Have you ever felt such a strong desire or urge to use any of the substances you have mentioned that you could not resist it or could not think of anything else?

YES 1

NO (GO TO F39) 2

IF F38=YES: ASK F38a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F38b-d

F38a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F38c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F38a)?

PROBE: "This" means ever felt such a strong desire or urge to use any of the substances you have mentioned that you could not resist it or could not think of anything else.

F38d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F38a)]?

PROBE: "This" means ever felt such a strong desire or urge to use any of the substances you have mentioned that you could not resist it or could not think of anything else.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F39. Did your use of any of these substances you have mentioned ever become so regular that you would not change when, or how much you took it, no matter what you were doing or where you were?

YES 1

NO (GO TO F40) 2

IF F39=YES: ASK F39a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F39b-d

F39a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F39b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F39a)?

PROBE: "This" means your use of any of these substances you have mentioned ever become so regular that you would not change when, or how much you took it, no matter what you were doing or where you were.

F39c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F39a)?

PROBE: "This" means your use of any of these substances you have mentioned ever become so regular that you would not change when, or how much you took it, no matter what you were doing or where you were.

F39d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F39a)]?

PROBE: "This" means your use of any of these substances you have mentioned ever become so regular that you would not change when, or how much you took it, no matter what you were doing or where you were.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F40. Have you ever tried to stop or cut down on [any of the substances] you have mentioned but found you could not?

YES 1

NO (GO TO F41) 2

IF F40=YES: ASK F40a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F40b-d

F40a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F40b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F40a)?

PROBE: "This" means ever tried to stop or cut down on any of the substances you have mentioned but found you could not.

F40c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F40a)?

PROBE: "This" means ever tried to stop or cut down on any of the substances you have mentioned but found you could not.

F40d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F40a)]?

PROBE: "This" means ever tried to stop or cut down on any of the substances you have mentioned but found you could not.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F41. Have you often wanted to quit or cut down on [any of the substances you have mentioned]?

YES 1

NO (GO TO F42) 2

IF F41=YES: ASK F41a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F41b-d

F41a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F41b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F41a)?

PROBE: "This" means ever wanted to quit or cut down on any of the substances you have mentioned.

F41c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F41a)?

PROBE: "This" means ever wanted to quit or cut down on any of the substances you have mentioned.

F41d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F41a)]?

PROBE: "This" means ever wanted to quit or cut down on any of the substances you have mentioned.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F42. Did you ever have a period of a month or more when you spent a great deal of time using [any of the substances you have mentioned] getting it, or getting over its effects?

YES 1

NO (GO TO F43) 2

IF F42=YES: ASK F42a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F42b-d

F42a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F42b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F42a)?

PROBE: "This" means ever have a period of a month or more when you spent a great deal of time using any of the substances you have mentioned getting it, or getting over its effects.

F42c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F42a)?

PROBE: "This" means ever have a period of a month or more when you spent a great deal of time using any of the substances you have mentioned getting it, or getting over its effects.

F42d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F42a)]?

PROBE: "This" means ever have a period of a month or more when you spent a great deal of time using any of the substances you have mentioned getting it, or getting over its effects.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F43. Did you often use much larger amounts of [any of the substances you have mentioned] than you intended to when you began, or did you use (it/them) for a longer period of time than you intended to?

YES 1

NO (GO TO F44) 2

IF F43=YES: ASK F43a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F43b-d

F43a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F43b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F43a)?

PROBE: "This" means often use much larger amounts of any of the substances you have mentioned than you intended to when you began, or did you use (it/them) for a longer period of time than you intended to.

F43c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F43a)?

PROBE: "This" means often use much larger amounts of any of the substances you have mentioned than you intended to when you began, or did you use (it/them) for a longer period of time than you intended to.

F43d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F43a)]?

PROBE: "This" means often use much larger amounts of any of the substances you have mentioned than you intended to when you began, or did you use (it/them) for a longer period of time than you intended to.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F44. Did you often start using [any of the substances you have mentioned] and find it difficult to stop before you became completely intoxicated or high?

Yes 1

No (GO TO F45) 2

IF F44=YES: ASK F44a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F44b-d

F44a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F44b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)?

PROBE: "This" means often start using any of the substances you have mentioned and find it difficult to stop before you became completely intoxicated or high.

F44c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)?

PROBE: "This" means often start using any of the substances you have mentioned and find it difficult to stop before you became completely intoxicated or high.

F44d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)]?

PROBE: "This" means often start using any of the substances you have mentioned and find it difficult to stop before you became completely intoxicated or high.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F45. Did you ever find that you had to use more of [any of the substances you have mentioned] than usual to get the same effect or that the same amount had less effect on you than before?

Yes 1

No (GO TO F46) 2

IF F45=YES: ASK F45a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F45b-d

F45a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

PROBE: Were there any other substances?

READ CATEGORIES IF NECESSARY

F45b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F45a)?

PROBE: "This" means ever find that you had to use more of any of the substances you have mentioned than usual to get the same effect or that the same amount had less effect on you than before.

F45c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F45a)?

PROBE: "This" means ever find that you had to use more of any of the substances you have mentioned than usual to get the same effect or that the same amount had less effect on you than before.

F45d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F45a)]?

PROBE: "This" means ever find that you had to use more of any of the substances you have mentioned than usual to get the same effect or that the same amount had less effect on you than before.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F46. I am going to read a list of problems caused by stopping or cutting down on [any of the substances that you have used]. Did stopping or cutting down on (this/these) substance(s) ever make you sick or cause you problems like:

Fatigue or exhaustion Muscle aches or cramps

Sweating Weakness

Fever Nausea or vomiting

Diarrhea Fits or seizures

Feeling anxious or depressed Runny eyes or nose

Trouble sleeping Yawning

Change in appetite Intense craving

The shakes (hands tremble) Seeing or hearing things that

Stomach ache were not really there

Headache Heart beating fast

YES 1

NO (GO TO F48) 2

IF F46=YES: ASK F46a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F46b-d

F46a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

F46b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F46a)?

PROBE: "This" means stopping or cutting down on (this/these) substance(s) ever make you sick or cause you problems, other than because of a hangover.

F46c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F46a)?

PROBE: "This" means stopping or cutting down on (this/these) substance(s) ever make you sick or cause you problems, other than because of a hangover.

F46d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F46a)]?

PROBE: "This" means stopping or cutting down on (this/these) substance(s) ever make you sick or cause you problems, other than because of a hangover.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F47. Did you ever use [any of the substances you have mentioned] to make these withdrawal symptoms go away or to keep from having them?

Yes 1

No (GO TO F48) 2

F47a. CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you continue to use?

ALCOHOL |___|

SEDATIVES |___|

TRANQUILIZERS |___|

STIMULANTS |___|

ANALGESICS |___|

INHALANTS |___|

MARIJUANA |___|

COCAINE |___|

HALLUCINOGENS |___|

HEROIN |___|

F48. Have you ever given up or greatly reduced important activities in order to get, or to use [any of the substances you have mentioned]—like sports, work, or seeing family and friends?

YES 1

NO (GO TO F49) 2

IF F48=YES: ASK F48a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F48b-d

F48a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances?

F48b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)?

PROBE: "This" means given up or greatly reduced important activities in order to get, or to use any of the substances you have mentioned -- like sports, work, or seeing family and friends.

F48c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)?

PROBE: "This" means given up or greatly reduced important activities in order to get, or to use any of the substances you have mentioned -- like sports, work, or seeing family and friends.

F48d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)]?

PROBE: "This" means given up or greatly reduced important activities in order to get, or to use any of the substances you have mentioned -- like sports, work, or seeing family and friends.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F49. Did [any of the substances you have mentioned] ever cause you recurrent problems with the police or other law enforcement (by recurrent we mean more than one occasion when you were encountered by the police, even if it did not result in an arrest)?

Yes 1

No (GO TO F50) 2

IF F49=YES: ASK F49a AND CHECK SUBSTANCES

FOR EACH SUBSTANCE CHECKED, ASK F49b-d

F49a.

CHECK CATEGORY OR IF MORE THAN ONE CATEGORY ASK: Which substances did you use?

F49b.

How old were you the first time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)?

PROBE: "This" means ever cause you recurrent problems with the police or other law enforcement, by recurrent we mean more than one occasion when you were encountered by the police, even if it did not result in an arrest.

F49c.

When was the last time this happened because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)?

PROBE: "This" means ever cause you recurrent problems with the police or other law enforcement, by recurrent we mean more than one occasion when you were encountered by the police, even if it did not result in an arrest.

F49d.

IF MORE THAN A YEAR AGO: How old were you the last time this happened [because of using (FILL WITH APPROPRIATE SUBSTANCE(S) FROM F44a)]?

PROBE: "This" means ever cause you recurrent problems with the police or other law enforcement, by recurrent we mean more than one occasion when you were encountered by the police, even if it did not result in an arrest.

|___| A. ALCOHOL

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| B. SEDATIVES

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| C. TRANQUILIZERS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| D. STIMULANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| E. ANALGESICS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| F. INHALANTS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| G. MARIJUANA

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| H. COCAINE

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| I. HALLUCINOGENS

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

|___| J. HEROIN

|___|___|

YEARS OLD

A MONTH AGO 1

6 MONTHS AGO 2

A YEAR AGO 3

MORE THAN A YEAR 4

|___|___|

YEARS OLD

F50. Did you ever tell a doctor other than a psychiatrist about your substance use? (Doctor includes medical doctors and students in training to be medical doctors.)

YES 1

NO (GO TO F54) 2

F50a. How old were you the first time you told a medical doctor other than a psychiatrist about your substance use?

|___|__|

YEARS OLD

F51. Did a medical doctor other than a psychiatrist ever prescribe medication for you because of your substance use?

YES 1

NO (GO TO F52) 2

F51a. How old were you the first time a medical doctor other than a psychiatrist prescribed medication for you because of your substance use?

|___|__|

YEARS OLD

F52. Did a medical doctor other than a psychiatrist ever advise you to see a mental health specialist (someone like a psychiatrist, psychologist or social worker) about your substance use?

YES 1

NO (GO TO F53) 2

F52a. How old were you the first time a medical doctor other than a psychiatrist advised you to see a mental health specialist?

|___|__|

YEARS OLD

F53. Did a medical doctor other than a psychiatrist ever refer you to a treatment program for alcohol or drug problems?

YES 1

NO (GO TO F54) 2

F53a. How old were you the first time a medical doctor other than a psychiatrist advised you to seek treatment at a substance abuse program?

|___|__|

YEARS OLD

F54. Did you ever use medication more than once because of your substance abuse?

YES 1

NO (GO TO F55) 2

F54a. How old were you the first time you took medication more than once because of your substance use?

|___|__|

YEARS OLD

F55. Did you ever see a mental health specialist about your substance use? (By mental health specialists we mean psychiatrists, psychologists, or social workers.)

YES 1

NO (GO TO F56) 2

F55a. How old were you the first time you saw a mental health specialist because of your substance abuse?

|___|__|

YEARS OLD

F56. Did you ever see any other professional about your substance use? (Other professionals include nurses, rabbis, priests, ministers, and counselors.)

YES 1

NO (GO TO F57) 2

F56a. How old were you the first time you saw any other professional because of your substance abuse?

|___|__|

YEARS OLD

F57. Did you ever go to a self-help group like Alcoholics Anonymous or Narcotics Anonymous because of your substance use?

YES 1

NO (GO TO SECTION CC) 2

F57a. How old were you the first time you went to a self-help group because of your substance use?

|___|__|

YEARS OLD

 

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