Drug and Alcohol Survey 2024
This form does not collect emails so feel free to answer honestly.
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Are you a Male or Female? *
What grade are you in? *
At what age did you have your first cigarette? *
In the past 30 days, how often have you smoked cigarettes? *
At what age did you have your first vape? *
In the past 30 days, how often have you vaped? *
In the past 30 days, how many times have you been in a car that was driven by someone under the influence? *
Either drugs or alcohol
At what age did you have your first drink of ALCOHOL? *
In the past 30 days, how many days did you have at LEAST one drink of ALCOHOL? *
At what age did you first use MARIJUANA?
Clear selection
During your lifetime, how many times have you used MARIJUANA? *
In the past 30 days, how many days have you USED MARIJUANA? *
In the past 30 days, how many days have you ABUSED PRESCRIPTION DRUGS? *
ABUSE- taken for reasons or in ways or amounts not intended by a doctor, or taken by someone other than the person for whom they are prescribed.
Have you ever ABUSED Pain Relievers- ex. Hydrocodone (Hydro), Oxycondone (Oxy), Percocet, Codeine, Vicodin? *
Have you ever ABUSED Dextromethorphan- ex. Cold Medicine, Robotussin *
Have you ever ABUSED Stimulants- ex. Adderall, Ritalin *
Have you ever ABUSED Depressants- ex. Xanax, Valium *
During your lifetime, how many times have you used INHALANTS? *
During your lifetime, how many times have you used ECSTASY? *
Molly, MDMA
During your lifetime, how many times have you used PSYCHEDELIC MUSHROOMS (SHROOMS)? *
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This form was created inside of New Lebanon Central School District. Report Abuse
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