Alcohol and Rx Survey
Youth Only
County of residence
Your answer
Age
Your answer
Grade
Your answer
Race
Your answer
Gender
Prescription drugs are much safer to abuse than street drugs.
I have (check all that apply)
How easy is it for someone your age to obtain a prescription drug to get high?
In your opinion, where do youth who abuse prescription drugs obtain it? (Circle up to 3)
Over-the-counter drugs are safer to abuse than Street Drugs
Over-the-counter drugs are safer to abuse than Prescription drugs
How many youth in the following categories do you think used prescription drugs (to get high or a reason other than prescribed) in the past month?
Almost None (10%)
Few (25%)
Half (50%)
Most (75%)
Almost All (90-100%)
Your Friends
Students In Your Grade
How wrong would the following people think it would be if you misused prescription drugs?
Not wrong at all
A little bit wrong
Wrong
Very wrong
Yourself
Your Friends
Your Parents
Do you agree or disagree with the following statements?
Strongly Disagree
Disagree
No Opinion
Agree
Strongly Agree
It is safer to get high on prescription medications than street drugs
Teens misuse prescription medications because they do not think they’re harmful
Teens misuse prescription medications to have fun at parties
Teens misuse prescription medications to help them study better
Teens misuse prescription medications to help them deal with problems
Teens misuse prescription medications to help them relax
In your opinion, where do teens most commonly misuse prescription medications?
In your opinion, when do teens most commonly misuse prescription medications?
If someone your age wanted to get the following, how easy would it be?
Very Hard/Can't Get
Fairly Hard
Fairly Easy
Very Easy
Not Sure
Alcohol
Marijuana
Prescription Drugs
Heroin
Where is alcohol stored in the home (Mark all that apply):
Where is alcohol stored in your friends' home (Mark all that apply):
I can get alcohol from (mark all that apply):
My friends have parties at their homes where alcohol is available.
Alcohol is available at (mark all that apply):
Alcohol is out of sight at my home.
Alcohol is out of sight at my friends' homes.
Do you agree with this statement: “My family has clear rules about alcohol and drug use.”
Is it unlikely or likely that when you are not at home your parents know where you are and who you are with?
Do your parents talk with you about the dangers of tobacco, alcohol and drug use?
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