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pdfNSDUH SUD Module
Cognitive Interview Study
Attachment I – Cognitive Interview Survey
Questions
Introduction
RxDrugs DID R SCREEN IN FOR PRESCRIPTION DRUGS?
1
2
Yes
No
Lang INTERVIEWER: SELECT THE LANGUAGE TO BE USED FOR THIS INTERVIEW.
1
2
ENGLISH
SPANISH
Version INTERVIEWER: SELECT WHICH VERSION OF THE INSTRUMENT
1
2
LONG-LASTING
LONG-LASTING OR REPEATED
NSDUH CAI Instrument Version:
XX
OMB Control #: 0930-0110
Expiration Date: 08/31/2020
Core Demographics
note1 FI: DO NOT READ ALOUD UNLESS RESPONDENT QUESTIONS THE BURDEN
(OR TIME) ASSOCIATED WITH THIS INTERVIEW.
NOTICE: Public reporting burden for this collection of information is estimated to
average 60 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing
this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project
(0930-0110); Center for Behavioral Health Statistics and Quality; 5600 Fishers Lane;
Room 15E57B; Rockville, MD 20857. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. The OMB control number for this project is 09300110.
PRESS [ENTER] TO CONTINUE.
age1
What is your date of birth?
ENTER MM-DD-YYYY
DOB: ________________
DK/REF
DEFINE CALCAGE:
CALCAGE = AGE CALCULATED BY "SUBTRACTING" DATE OF BIRTH FROM DATE
OF INTERVIEW.
confdob
[IF AGE1 NE DK OR REF] I have entered your date of birth as [AGE1]. Is this
correct?
1
YES
2
NO
DK/REF
HARD ERROR: [IF CONFDOB=2] INTERVIEWER: PRESS [ENTER] TO GO BACK
AND CORRECT THE RESPONDENT’S DATE OF BIRTH.
[NOTE: DO NOT DEFINE CALCAGE UNTIL CONFDOB=YES]
confirm
[IF AGE1 NE DK/REF AND CONFDOB NE DK/REF] That would make you
[CALCAGE] years old. Is this correct?
1
YES
2
NO
DK/REF
HARD ERROR: [IF CONFIRM = 2] INTERVIEWER: PRESS [ENTER] TO GO BACK
AND CORRECT THE RESPONDENT’S DATE OF BIRTH.
under12 [IF CONFIRM = 1 OR DK/REF AND CALCAGE < 12] Since you are
[CALCAGE] years old, we cannot interview you for this study. Thank you for your
cooperation.
PRESS [ENTER] TO CONTINUE. PROGRAM SHOULD ROUTE TO FIEXIT.
QD01 INTERVIEWER: RECORD RESPONDENT’S GENDER.
5
9
MALE
FEMALE
Beginning ACASI Section
IntroAcasi1 You will do an important part of this interview on your own, using the computer
and headphones.
Before you start, we’ll go through a short practice session so you can learn how to use this
computer and our interview program. Let me quickly point out the keys you will use. The
computerized practice session that follows will go through what each key does in greater detail.
MOVE COMPUTER SO RESPONDENT CAN SEE THE KEYBOARD AND POINT OUT
THE FOLLOWING:
[POINT TO THE ROW OF FUNCTION KEYS] First, these are the function keys. The function
keys and what they do are labeled for you.
[POINT TO F3] If you don’t know the answer to a question, press F3.
[POINT TO F4] If you don’t want to answer a question, press F4.
PRESS [ENTER] TO CONTINUE.
IntroAcasi3 These next items will help you enter your answers into the computer.
[POINT TO THE ROW OF NUMBER KEYS] These are the number keys.
[POINT TO THE ENTER KEY] The Enter key is here,
[POINT TO THE SPACE BAR] the space bar is here,
[POINT TO THE BACKSPACE KEY] and the Backspace key is here.
[POINT TO THE BOTTOM OF THE SCREEN] The answers that you enter will show up here
at the bottom of the screen.
PRESS [ENTER] TO CONTINUE.
IntroAcasi4 There are a couple of computer features that you will not use.
[POINT TO ON/OFF SWITCH] This button up here turns the machine on and off. Please do not
press it! It will turn the machine off, and we’ll lose the interview.
[POINT TO TOUCHPAD] Also, please do not touch this pad. This might disrupt the interview.
PRESS [ENTER] TO CONTINUE.
IntroAcasi2 These headphones will allow you to listen while the computer voice reads the
interview questions.
HAND HEADPHONES TO RESPONDENT.
You can adjust the volume here [DEMONSTRATE VOLUME ADJUSTMENT ON THE
HEADPHONE CORD].
Please put on your headphones. When you are ready, let me know.
MOVE COMPUTER SO RESPONDENT CAN USE IT.
ONCE RESPONDENT HAS HEADPHONES ON, PRESS “1" AND [ENTER] SO R CAN
BEGIN PRACTICE SESSION.
HeadPhone This screen will play while you adjust the volume in your headphones. When you
have adjusted the volume to a level that is comfortable to you, press the large [ENTER] key on
the right side of the keyboard to continue with the practice session. The [ENTER] key is the one
with the symbol on it.
Tutorial
INTRO1 Welcome to RTI’s self-interviewing system, which lets you control the interview and
answer in complete privacy.
First, you will learn how to use the system and complete some practice questions. You will learn
how to enter answers and how to back-up if you make a mistake and want to change an answer.
Press the large [ENTER] key on the right side of the keyboard to move to the next screen. The
[ENTER] key is the one that says ENTER and has a symbol on it.
INTRO2 In this system you can read the questions on the computer screen and hear them read
through the headphones. If you would like to just see the questions on the screen, you can turn
down the voice.
Press [ENTER] to continue.
GOTDOG You answer questions by putting in the number that is shown next to your answer.
The numbers are located in the second row of the keyboard.
To answer a question, you first press the correct number and then press [ENTER].
Practice Question #1: Do you have a dog?
1
Yes
2
No
DK/REF
EYECOLOR The last question was a Yes-No question. Other questions will have more
answers to choose from, and you will pick your answer from a list.
Practice Question #2: What color are your eyes? Put in the number that best fits you and press
[ENTER].
1
Blue
2
Brown
3
Gray
4
Green
5
Some other color
DK/REF
ALLAPPLY Some questions will let you choose more than one answer. For these questions,
you will use the space bar to separate the answers you type in. Practice this now.
Practice Question #3: What kinds of music do you listen to?
To select more than one kind of music from the list, press the space bar between each number
you type. When you have finished, press [ENTER] to go to the next question.
1
Classical
2
Country
3
Hip Hop
4
Jazz
5
Latin American/Spanish
6
Folk/Traditional
7
Pop/Rock
8
Soul/R&B
9
Something Else
DK/REF
NOTUSED For some questions, you may want to answer that you have not done any of the
things listed. In these questions, the computer will instruct you to enter ‘95’ to indicate that you
have not done these things. Try this now.
Practice Question #4: In the past 12 months, which, if any, of these musical instruments have
you played?
1
Banjo
2
Tuba
1
Bagpipes
95
I have not played any of these musical instruments in the past 12 months.
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, OR 3.
NUMBER Other questions will ask you to type in a number instead of choosing a number from
a list.
Practice Question #5: In the past 30 days, on how many days did you eat breakfast? Type in the
number of days you ate breakfast and press [ENTER].
________[RANGE: 0 - 30]
DK/REF
GRID In some cases there will be more than one question to answer on a screen. For these
questions, you will enter your answers one at a time in the order the questions are shown on the
screen.
Practice Question #6: Have you eaten the following types of fruit in the past 30 days?
Yes
No
GRID1 Apples
GRID2 Bananas?
1
1
2
2
DK/REF
BACKUP
If you want to change or see your answer to a previous question, you can back up
using the [F9] key. Each time you press the [F9] key, the computer will go back one question.
You can tell the computer to repeat a question by pressing [F10]. Try this now.
When you are finished, press [ENTER] to continue.
PLAYINFO In some questions, you can use the [F2] key to see and hear extra information to
help you answer a question.
First listen to the question.
Practice Question #7: In the past 30 days, on how many days did you eat any kind of fried
potatoes?
________________ [RANGE: 0 - 30]
DK/REF
Now press [F2] to see and hear examples of
fried potatoes.
French fries
Home fries
Hash brown potatoes
Press [ENTER] to close this box. Then, type
in your response to the question.
rangeerr
For some questions, the computer can only accept certain answers. For example,
in the question below, the only numbers the computer will accept are 1 for YES or 2 for NO.
If you try to enter some other number, an instruction box will appear. To correct your answer,
you must press [ENTER] to make the box disappear. You can then answer the question again.
Try this with the question below. Type a 3 as your answer. Press [ENTER] to remove the
instruction box, then type in a valid answer.
Practice Question #8: Do you have a cat?
1
Yes
2
No
DK/REF
Calendar
Calendar Throughout the rest of this interview, the computer will ask you questions about three
time periods, the past 30 days, the past 12 months, and your lifetime. To help you remember the
first two time periods, the computer will record the beginning dates for each one of them.
PROGRAMMER: 30 DAY CALENDAR WILL DISPLAY
Now please think about the past 30 days. According to the calendar [DATEFILL] was 30 days
ago. That will be your 30-day reference date, and can be found in blue on the calendar. The
entire 30-day period is highlighted in yellow.
PROGRAMMER: Fill date on 30 day reference date field and highlight the 30-day reference
date. CIRCLE DAY; HIGHLIGHT ENTIRE 30-DAY PERIOD. MAKE TEXT THAT SAYS
‘BLUE’ BLUE IN COLOR.
Press [ENTER] to continue.
calendr2 A number of questions will ask about the past 12 months, that is since this date last
year. According to the calendar [DATEFILL] was 12 months ago. That will be your 12-month
reference date and can be found in red on the calendar. Today’s date can be found in green.
PROGRAMMER: Fill date on 12 month reference date field and highlight the 12 month
reference date. CIRCLE DAY. MAKE TEXT THAT SAYS ‘RED’ RED IN COLOR AND
THE SAME FOR GREEN TEXT.
Press [ENTER] to continue.
calendr3 Please use the calendar as you go through the interview to help you remember when
different things happened. The calendars will pop up to remind you to think about your 30-day
reference date and your 12-month reference date when you answer questions. You can also look
at the calendar at any time by pressing [F1]. Press [F1] again to close the calendar.
Press [ENTER] to continue.
ANYQUES If you have any questions, please ask your interviewer now. If not, press [ENTER]
to begin.
Alcohol
ALCINTR1 The next questions are about alcoholic beverages, such as beer, wine, brandy, and
mixed drinks. Listed on the next screen are examples of the types of beverages we are interested
in.
Please review this list carefully before you answer these questions.
Press [ENTER] to continue.
CARD3a
Types of Alcoholic Beverages
Beer
Regular Beer
Lite or light beer
Low-alcohol (LA) beer
Wine
Red, white, blush wine
Wine coolers
Champagne
Liquor
Bourbon
Gin
Rum
Malt liquor
Ale
Stout
Sherry
Fortified wines, such
as Cisco
Homemade wines,
such as muscadine,
scuppernong, or fruit
wines
Scotch
such as moonshine
Tequila
Vodka
Liqueurs, Cordials, and Brandy
Brandy
Drambuie
Cassis
Grand Marnier
Cognac
Kahlua
Creme de menthe
Port
Mixed Drinks and Cocktails
Bloody Mary
Manhattan
Bourbon and water Margarita
Daiquiri
Martini
Gin and tonic
Piña colada
Press [ENTER] to continue.
Lager
Homemade liquor,
Schnapps
Tia Maria
Triple sec
Vermouth
Rob Roy
Rum and cola
Scotch and soda
Whiskey sour
ALCINTR2 These questions are about drinks of alcoholic beverages. Throughout these
questions, by a “drink,” we mean a can or bottle of beer, a glass of wine or a wine cooler, a shot
of liquor, or a mixed drink with liquor in it. We are not asking about times when you only had a
sip or two from a drink.
Press [ENTER] to continue.
AL01 Have you ever, even once, had a drink of any type of alcoholic beverage? Please do not
include times when you only had a sip or two from a drink.
1
Yes
2
No
DK/REF
ALREF [IF AL01 = REF] The answers that people give us about their use of alcohol are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, had a drink of any
type of alcoholic beverage? Please do not include times when you only had a sip or two from a
drink.
1
Yes
2
No
DK/REF
ALLAST3 [IF AL01 = 1 OR ALREF = 1] How long has it been since you last drank an
alcoholic beverage?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ALRECDK [IF ALLAST3 = DK] What is your best guess of how long it has been since you
last drank an alcoholic beverage?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ALRECRE [IF ALLAST3 = REF] The answers that people give us about their use of alcohol
are important to this study’s success. We know that this information is personal, but remember
your answers will be kept confidential.
Please think again about answering this question: How long has it been since you last drank an
alcoholic beverage?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ALFRAME3 [IF ALLAST3 = 1 OR 2 OR ALRECDK = 1 OR 2 OR ALRECRE = 1 OR 2]
Now think about the past 12 months, from [DATEFILL] through today. We want to know how
many days you’ve had a drink of an alcoholic beverage during the past 12 months.
What would be the easiest way for you to tell us how many days you drank alcoholic beverages?
1
Average number of days per week during the past 12 months
2
Average number of days per month during the past 12 months
3
Total number of days during the past 12 months
DK/REF
ALYRAVE [IF ALFRAME3 = 3 OR DK/REF] On how many days in the past 12 months did
you drink an alcoholic beverage?
TOTAL # OF DAYS:
[RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ALMONAVE [IF ALFRAME3 = 2 OR ALYRAVE = DK/REF] On average, how many days
did you drink an alcoholic beverage each month during the past 12 months?
AVG # OF DAYS PER MONTH:
[RANGE: 1 - 31]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
ALWKAVE [IF ALFRAME3 = 1 OR ALMONAVE = DK/REF] On average, how many days
did you drink an alcoholic beverage each week during the past 12 months?
AVG # OF DAYS PER WEEK:
[RANGE: 1 - 7]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DEFINE TOTDRINK:
IF ALYRAVE NOT (BLANK OR DK/REF) THEN TOTDRINK=ALYRAVE
ELSE IF ALMONAVE NOT (BLANK OR DK/REF) THEN TOTDRINK=ALMONAVE*12
ELSE IF ALWKAVE NOT (BLANK OR DK/REF) THEN TOTDRINK = ALWKAVE*52
ELSE TOTDRINK=DK/REF
Marijuana
MRJINTRO The next questions are about marijuana and hashish. Marijuana is also called pot
or grass. Marijuana is usually smoked, either in cigarettes, called joints, or in a pipe. It is
sometimes cooked in food. Hashish is a form of marijuana that is also called “hash.” It is
usually smoked in a pipe. Another form of hashish is hash oil.
Press [ENTER] to continue.
MJ01 Have you ever, even once, used marijuana or hashish?
1
Yes
2
No
DK/REF
MJREF [IF MJ01 = REF] The answers that people give us about their use of marijuana and
hashish are important to this study’s success. We know that this information is personal, but
remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used marijuana or
hashish?
1
Yes
2
No
DK/REF
MJLAST3 [IF MJ01 = 1 OR MJREF = 1] How long has it been since you last used marijuana
or hashish?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MJRECDK [IF MJLAST3 = DK] What is your best guess of how long it has been since you
last used marijuana or hashish?
1
2
Within the past 30 days — that is, since [DATEFILL]
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MJRECRE [IF MJLAST3 = REF] The answers that people give us about their use of marijuana
and hashish are important to this study’s success. We know that this information is personal, but
remember your answers will be kept confidential.
Please think again about answering this question: How long has it been since you last used
marijuana or hashish?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MJFRAME3 [IF MJLAST3 = 1 - 2 OR MJRECDK = 1 - 2 OR MJRECRE = 1 - 2] Now think
about the past 12 months, from [DATEFILL] through today. We want to know how many days
you’ve used marijuana or hashish during the past 12 months.
What would be the easiest way for you to tell us how many days you’ve used it?
1
Average number of days per week during the past 12 months
2
Average number of days per month during the past 12 months
3
Total number of days during the past 12 months
DK/REF
MJYRAVE [IF MJFRAME3 = 3 OR DK/REF] On how many days in the past 12 months did
you use marijuana or hashish?
TOTAL # OF DAYS:
[RANGE: 1 - 366]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MJMONAVE
[IF MJFRAME3 = 2 OR MJYRAVE = DK/REF] On average, how many
days did you use marijuana or hashish each month during the past 12 months?
AVERAGE # OF DAYS PER MONTH:
[RANGE: 1 - 31]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MJWKAVE [IF MJFRAME3 = 1 OR MJMONAVE = DK/REF] On average, how many days
did you use marijuana or hashish each week during the past 12 months?
AVERAGE # OF DAYS PER WEEK:
[RANGE: 1 - 7]
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DEFINE TOTMJ:
IF MJYRAVE NOT (BLANK OR DK/REF) THEN TOTMJ = MJYRAVE
ELSE IF MJMONAVE NOT (BLANK OR DK/REF) THEN TOTMJ = MJMONAVE*12
ELSE IF MJWKAVE NOT (BLANK OR DK/REF) THEN TOTMJ = MJWKAVE*52
ELSE TOTMJ = DK/REF
IF TOTMJ = DK/REF, SKIP TO COCINTRO
Cocaine
COCINTRO These questions are about cocaine, including all the different forms of cocaine
such as powder, ‘crack,’ free base, and coca paste.
Press [ENTER] to continue.
CC01 Have you ever, even once, used any form of cocaine?
1
Yes
2
No
DK/REF
CCREF [IF CC01 = REF] The answers that people give us about their use of cocaine are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used any form of
cocaine?
1
Yes
2
No
DK/REF
CCLAST3 [IF CC01 = 1 OR CCREF = 1] How long has it been since you last used any form of
cocaine?
1
Within the past 30 days -- that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
CCRECDK [IF CCLAST3 = DK] What is your best guess of how long it has been since you
last used cocaine?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
CCRECRE [IF CCLAST3 = REF] The answers that people give us about their use of cocaine
are important to this study’s success. We know that this information is personal, but remember
your answers will be kept confidential.
Please think again about answering this question: How long has it been since you last used
cocaine?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Heroin
HEINTRO These next questions are about heroin.
Press [ENTER] to continue.
HE01 Have you ever, even once, used heroin?
1
Yes
2
No
DK/REF
HEREF [IF HE01 = REF] The answers that people give us about their use of heroin are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used heroin?
1
Yes
2
No
DK/REF
HELAST3 [IF HE01 = 1 OR HEREF = 1] How long has it been since you last used heroin?
1
Within the past 30 days -- that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
HERECDK [IF HELAST3 = DK] What is your best guess of how long it has been since you
last used heroin?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
HERECRE [IF HELAST3 = REF] The answers that people give us about their use of heroin are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: How long has it been since you last used
heroin?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Hallucinogens
HALINTRO The next questions are about substances called hallucinogens. These drugs often
cause people to see or experience things that are not real.
A list of some common hallucinogens is shown below. These and many other substances that
people use as hallucinogens are often known by street names, and we can’t list them all. Please
take a moment to look at the substances listed below so you know what kind of drugs the next
questions are about.
LSD, also called ‘acid’
PCP, also called ‘angel dust’ or phencyclidine
Peyote
Mescaline
Psilocybin
‘Ecstasy’ or ‘Molly’, also called MDMA
Ketamine, also called “Special K” or “Super K”
DMT, also called dimethyltryptamine
AMT, also called alpha-methyltryptamine
Foxy, also called 5-MeO-DIPT
Salvia divinorum
Press [ENTER] to continue.
LS01a Have you ever, even once, used LSD, also called “acid”?
1
Yes
2
No
DK/REF
LSREF1
[IF LS01a = REF] The answers that people give us about their use of LSD are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used LSD, also
called ‘acid’?
1
Yes
2
No
DK/REF
LS01b Have you ever, even once, used PCP, also called ‘angel dust’ or phencyclidine?
1
Yes
2
No
DK/REF
LSREF2
[IF LS01b = REF] The answers that people give us about their use of PCP are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used PCP, also
called ‘angel dust’ or phencyclidine?
1
Yes
2
No
DK/REF
LS01c Have you ever, even once, used peyote?
1
Yes
2
No
DK/REF
LS01d Have you ever, even once, used mescaline?
1
Yes
2
No
DK/REF
LS01e Have you ever, even once, used psilocybin, found in mushrooms?
1
Yes
2
No
DK/REF
LS01f Have you ever, even once, used ‘Ecstasy’ or ‘Molly’, also known as MDMA?
1
Yes
2
No
DK/REF
LSREF3
[IF LS01f = REF] The answers that people give us about their use of ‘Ecstasy’ or
‘Molly’ are important to this study’s success. We know that this information is personal, but
remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used ‘Ecstasy’ or
‘Molly’, also known as MDMA?
1
Yes
2
No
DK/REF
LS01i Have you ever, even once, used Ketamine, also called “Special K” or “Super K”?
1
Yes
2
No
DK/REF
LS01j Have you ever, even once, used any of the following:
DMT, also called dimethyltryptamine
AMT, also called alpha-methyltryptamine, or
Foxy, also called 5-MeO-DIPT?
1
Yes
2
No
DK/REF
LS01k Have you ever, even once, used Salvia divinorum?
1
Yes
2
No
DK/REF
LS01h Have you ever, even once, used any other hallucinogens besides the ones that have been
listed?
1
Yes
2
No
DK/REF
LS01hs1 [IF LS01h = 1] Please type in the name of the other hallucinogens you have used. If
you’re not sure how to spell the name of the hallucinogen you used, just make your best guess.
When you have finished, press the [ENTER] key to go to the next question. Remember, you do
not need to type in the names of any hallucinogens that you already reported.
________________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN LS01hs1.
DEFINE LSFILL:
IF (LS01a = 1 OR LSREF1 = 1) AND ((LS01b = 2 OR LSREF2 = 2) AND LS01c = 2 AND
LS01d = 2 AND LS01e = 2 AND (LS01f = 2 OR LSREF3 = 2) AND LS01h = 2 AND LS01i=2
AND LS01j=2 AND LS01k=2), LSFILL = “LSD”
IF (LS01a = 1 OR LSREF1 = 1) AND ( LS01b NE 1 AND LSREF2 NE 1 AND LS01c NE
1 AND LS01d NE 1 AND LS01e NE 1 AND LS01f NE 1 AND LSREF3 NE 1 AND LS01h NE
1 AND LS01i NE 1 AND LS01j NE 1 AND LS01k NE 1) AND ( (LS01b = DK OR (LS01b =
REF AND LSREF2 = DK/REF) OR LS01c = DK/REF OR LS01d = DK/REF OR LS01e =
DK/REF OR LS01f = DK OR (LS01f = REF AND LSREF3 = DK/REF) OR LS01h = DK/REF
OR LS01i=DK/REF OR LS01j=DK/REF OR LS01k=DK/REF) ) LSFILL = "LSD or any other
hallucinogen"
IF (LS01b = 1 OR LSREF2 = 1) AND ((LS01a = 2 OR LSREF1 = 2) AND LS01c = 2 AND
LS01d = 2 AND LS01e = 2 AND (LS01f = 2 OR LSREF3 = 2) AND LS01h = 2 AND LS01i=2
AND LS01j=2 AND LS01k=2), LSFILL = “PCP”
IF (LS01b = 1 OR LSREF2 = 1) AND ( LS01a NE 1 AND LSREF1 NE 1 AND LS01c NE
1 AND LS01d NE 1 AND LS01e NE 1 AND LS01f NE 1 AND LSREF3 NE 1 AND LS01h NE
1 AND LS01i NE 1 AND LS01j NE 1 AND LS01k NE 1) AND ( (LS01a = DK OR (LS01a =
REF AND LSREF1 = DK/REF) OR LS01c = DK/REF OR LS01d = DK/REF OR LS01e =
DK/REF OR LS01f = DK OR (LS01f = REF AND LSREF3 = DK/REF) OR LS01h = DK/REF
OR LS01i=DK/REF OR LS01j=DK/REF OR LS01k=DK/REF) ) LSFILL = "PCP or any other
hallucinogen"
IF (LS01f = 1 OR LSREF3 = 1) AND ((LS01a = 2 OR LSREF1 = 2) AND (LS01b = 2 OR
LSREF2 = 2) AND LS01c = 2 AND LS01d = 2 AND LS01e = 2 AND LS01h = 2 AND
LS01i=2 AND LS01j=2 AND LS01k=2), LSFILL = “‘Ecstasy’ or ‘Molly’”
IF (LS01f = 1 OR LSREF3 = 1) AND (LS01a NE 1 AND LSREF1 NE 1 AND LS01b NE 1
AND LSREF2 NE 1 AND LS01c NE 1 AND LS01d NE 1 AND LS01e NE 1 AND LS01h NE 1
AND LS01i NE 1 AND LS01j NE 1 AND LS01k NE 1) AND ( LS01a=DK OR (LS01a=REF
AND LSREF1=DK/REF) OR(LS01b = DK OR (LS01b = REF AND LSREF2 = DK/REF)
OR LS01c = DK/REF OR LS01d = DK/REF OR LS01e = DK/REF OR LS01h = DK/REF OR
LS01i=DK/REF OR LS01j=DK/REF OR LS01k=DK/REF) ) LSFILL = "”Ecstasy”, ‘Molly’, or
any other hallucinogen"
IF (LS01i = 1) AND ((LS01a = 2 OR LSREF1 = 2) AND (LS01b = 2 OR LSREF2 = 2) AND
LS01c = 2 AND LS01d = 2 AND LS01e = 2 AND (LS01f=2 OR LSREF3=2) AND LS01h = 2
AND LS01j=2 AND LS01k=2), LSFILL = “Ketamine”
IF (LS01i = 1) AND (LS01a NE 1 AND LSREF1 NE 1 AND LS01b NE 1 AND LSREF2 NE 1
AND LS01c NE 1 AND LS01d NE 1 AND LS01e NE 1 AND LS01f NE 1 AND LSREF3 NE 1
AND LS01h NE 1 AND LS01j NE 1 AND LS01k NE 1) AND ( LS01a=DK OR (LS01a=REF
AND LSREF1=DK/REF) OR(LS01b = DK OR (LS01b = REF AND LSREF2 = DK/REF)
OR LS01c = DK/REF OR LS01d = DK/REF OR LS01e = DK/REF OR LS01f = DK OR
(LS01f = REF AND LSREF3 = DK/REF) OR LS01h = DK/REF OR LS01j=DK/REF OR
LS01k=DK/REF) ) LSFILL = "Ketamine or any other hallucinogen"
IF (LS01j = 1) AND ((LS01a = 2 OR LSREF1 = 2) AND (LS01b = 2 OR LSREF2 = 2) AND
LS01c = 2 AND LS01d = 2 AND LS01e = 2 AND (LS01f=2 OR LSREF3=2) AND LS01h = 2
AND LS01i=2 AND LS01k=2), LSFILL = “DMT, AMT, or Foxy”
IF (LS01j = 1) AND (LS01a NE 1 AND LSREF1 NE 1 AND LS01b NE 1 AND LSREF2 NE 1
AND LS01c NE 1 AND LS01d NE 1 AND LS01e NE 1 AND LS01f NE 1 AND LSREF3 NE 1
AND LS01h NE 1 AND LS01i NE 1 AND LS01k NE 1) AND ( LS01a=DK OR (LS01a=REF
AND LSREF1=DK/REF) OR(LS01b = DK OR (LS01b = REF AND LSREF2 = DK/REF)
OR LS01c = DK/REF OR LS01d = DK/REF OR LS01e = DK/REF OR LS01f = DK OR
(LS01f = REF AND LSREF3 = DK/REF) OR LS01h = DK/REF OR LS01i=DK/REF OR
LS01k=DK/REF) ) LSFILL = "DMT, AMT, Foxy or any other hallucinogen"
IF (LS01k = 1) AND ((LS01a = 2 OR LSREF1 = 2) AND (LS01b = 2 OR LSREF2 = 2) AND
LS01c = 2 AND LS01d = 2 AND LS01e = 2 AND (LS01f=2 OR LSREF3=2) AND LS01h = 2
AND LS01i=2 AND LS01j=2), LSFILL = “Salvia divinorum”
IF (LS01k = 1) AND (LS01a NE 1 AND LSREF1 NE 1 AND LS01b NE 1 AND LSREF2 NE 1
AND LS01c NE 1 AND LS01d NE 1 AND LS01e NE 1 AND LS01f NE 1 AND LSREF3 NE 1
AND LS01h NE 1 AND LS01i NE 1 AND LS01j NE 1) AND ( LS01a=DK OR (LS01a=REF
AND LSREF1=DK/REF) OR(LS01b = DK OR (LS01b = REF AND LSREF2 = DK/REF)
OR LS01c = DK/REF OR LS01d = DK/REF OR LS01e = DK/REF OR LS01f = DK OR
(LS01f = REF AND LSREF3 = DK/REF) OR LS01h = DK/REF OR LS01i=DK/REF OR
LS01j=DK/REF) ) LSFILL = "Salvia divinorum or any other hallucinogen"
ELSE, LSFILL = “any hallucinogen”
LSLAST [IF LS01a = 1 OR LSREF1 = 1 OR LS01b = 1 OR LSREF2 = 1 OR LS01c = 1 OR
LS01d = 1 OR LS01e = 1 OR LSREF3 = 1 OR LS01f = 1 OR LS01h = 1 OR LS01i=1 OR
LS01j=1 OR LS01k=1] How long has it been since you last used [LSFILL]?
1
Within the past 30 days -- that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
LSRECDK [IF LSLAST = DK] What is your best guess of how long it has been since you last
used [LSFILL]?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
LSRECRE [IF LSLAST = REF] The answers that people give us about their use of
hallucinogens are important to this study’s success. We know that this information is
personal, but remember your answers will be kept confidential.
Please think again about answering this question: How long has it been since you
last used [LSFILL]?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DEFINE HALLREC:
IF LSLAST = 1 OR LSRECDK = 1 OR LSRECRE = 1, THEN HALLREC = 1
IF LSLAST = 2 OR LSRECDK = 2 OR LSRECRE = 2, THEN HALLREC = 2
IF LSLAST = 3 OR LSRECDK = 3 OR LSRECRE = 3, THEN HALLREC = 3
ELSE HALLREC = BLANK
Inhalants
INHINTRO These next questions are about liquids, sprays, and gases that people sniff or
inhale to get high or to make them feel good.
We are not interested in times when you inhaled a substance accidentally — such as when
painting, cleaning an oven, or filling a car with gasoline. The questions use the word ‘inhalant’
to include all the things listed below, as well as any other substances that people sniff or inhale
for kicks or to get high. Take a moment to look at the substances listed below so you know what
kinds of liquids, sprays, and gases these questions are about.
Amyl nitrite, ‘poppers,’ locker room odorizers, or ‘rush’
Correction fluid, degreaser, or cleaning fluid
Gasoline or lighter fluid
Glue, shoe polish, or toluene
Halothane, ether, or other anesthetics
Lacquer thinner, or other paint solvents
Lighter gases, such as butane or propane
Nitrous oxide or ‘whippits’
Felt-tip pens, felt-tip markers, or magic markers
Spray paints
Computer keyboard cleaner, also known as air duster
Other aerosol sprays
Press [ENTER] to continue.
IN01a Have you ever, even once, inhaled amyl nitrite, ‘poppers,’ locker room odorizers, or
‘rush’ for kicks or to get high?
1
Yes
2
No
DK/REF
IN01b Have you ever, even once, inhaled correction fluid, degreaser, or cleaning fluid for kicks
or to get high?
1
Yes
2
No
DK/REF
IN01c Have you ever, even once, inhaled gasoline or lighter fluid for kicks or to get high?
1
Yes
2
No
DK/REF
IN01d Have you ever, even once, inhaled glue, shoe polish, or toluene for kicks or to get high?
1
Yes
2
No
DK/REF
IN01e Have you ever, even once, inhaled halothane, ether, or other anesthetics for kicks or to
get high?
1
Yes
2
No
DK/REF
IN01f Have you ever, even once, inhaled lacquer thinner or other paint solvents for kicks or to
get high?
1
Yes
2
No
DK/REF
IN01g Have you ever, even once, inhaled lighter gases, such as butane or propane for kicks or to
get high?
1
Yes
2
No
DK/REF
IN01h Have you ever, even once, inhaled nitrous oxide or ‘whippits’ for kicks or to get high?
1
Yes
2
No
DK/REF
IN01h1
Have you ever, even once, inhaled felt-tip pens, felt-tip markers, or magic
markers for kicks or to get high?
1
Yes
2
No
DK/REF
IN01i Have you ever, even once, inhaled spray paints for kicks or to get high?
1
Yes
2
No
DK/REF
IN01ii Have you ever, even once, inhaled computer keyboard cleaner, also known as air duster,
for kicks or to get high?
1
Yes
2
No
DK/REF
IN01j Have you ever, even once, inhaled some other aerosol spray for kicks or to get high?
1
Yes
2
No
DK/REF
IN01l Have you ever, even once, used any other inhalants for kicks or to get high besides the
ones that have been listed?
1
Yes
2
No
DK/REF
IN01OTH1 [IF IN01l = 1] Please type in the name of one of the other inhalants you have used.
If you’re not sure how to spell the name of the inhalant you used, just make your best guess.
When you have finished, press the [ENTER] key to go to the next question. Remember, you do
not need to type in the names of any inhalants that you already reported.
______________
DK/REF
PROGRAMMER: DO NOT ALLOW BLANKS IN IN01OTH1.
INREF [IF IN01a = REF AND IN01b = REF AND IN01c = REF AND IN01d = REF AND
IN01e = REF AND IN01f = REF AND IN01g = REF AND IN01h = REF AND IN01h1 = REF
AND IN01i = REF AND IN01ii = REF AND IN01j = REF AND IN01l = REF] The answers
people give about their use of inhalants are important to this study’s success. We know that this
information is personal, but remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used any type of
inhalant for kicks or to get high?
1
Yes
2
No
DK/REF
INLAST [IF IN01a = 1 OR IN01b = 1 OR IN01c = 1 OR IN01d = 1 OR IN01e = 1 OR IN01f =
1 OR IN01g = 1 OR IN01h = 1 OR IN01h1=1 OR IN01i = 1 OR IN01ii=1 OR IN01j = 1 OR
IN01L = 1 OR INREF = 1] How long has it been since you last used any inhalant for kicks or to
get high?
1
Within the past 30 days – that is, since [DATEFILL]
2
More than 30 days ago but with the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
INRECDK [IF INLAST = DK] What is your best guess of how long it has been since you last
used any inhalant for kicks or to get high?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
INRECRE [IF INLAST = REF] The answers that people give us about their use of inhalants are
important to this study’s success. We know that this information is personal, but remember your
answers will be kept confidential.
Please think again about answering this question: How long has it been since you last used any
inhalant for kicks or to get high?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Methamphetamine
METHINTRO Methamphetamine, also known as crank, ice, crystal meth, speed, glass, and
many other names, is a stimulant that usually comes in crystal or powder forms. It can be
smoked, “snorted,” swallowed or injected.
Press [ENTER] to continue.
ME01 Have you ever, even once, used methamphetamine?
1
Yes
2
No
DK/REF
MEREF
[IF ME01 = REF] The answers that people give about their use of
methamphetamine are important to this study’s success. We know that this information is
personal, but remember your answers will be kept confidential.
Please think again about answering this question: Have you ever, even once, used
methamphetamine?
1
Yes
2
No
DK/REF
MELAST3 [IF ME01 = 1 OR MEREF = 1] How long has it been since you last used
methamphetamine?
1
Within the past 30 days -- that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MERECDK [IF MELAST3 = DK] What is your best guess of how long it has been since you
last used methamphetamine?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
MERECRE [IF MELAST3 = REF] The answers that people give us about their use of
methamphetamine are important to this study’s success. We know that this information is
personal, but remember your answers will be kept confidential.
Please think again about answering this question: How long has it been since you last used
methamphetamine?
1
Within the past 30 days — that is, since [DATEFILL]
2
More than 30 days ago but within the past 12 months
3
More than 12 months ago
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Definitions for Use in the Drugs Module 1
DEFINE ALC12MON:
IF (ALLAST3 = 1 OR 2 OR ALRECDK = 1 OR 2 OR ALRECRE = 1 OR 2) AND
TOTDRINK = DK/REF, THEN ALC12MON = 1
ELSE TOTDRINK > 5, THEN ALC12MON = 2
ELSE, ALC12MON = 4
DEFINE MAR12MON:
IF (MJLAST3 = 1 OR 2 OR MJRECDK = 1 OR 2 OR MJRECRE = 1 OR 2) AND
TOTMJ = DK/REF, THEN MAR12MON = 1
ELSE TOTMJ > 5, THEN MAR12MON = 2
ELSE MAR12MON = 4
DEFINE COC12MON:
IF CCLAST3 = 1 OR 2 OR CCRECDK = 1 OR 2 OR CCRECRE = 1 OR 2, THEN
COC12MON = 1
ELSE COC12MON = 2
DEFINE HER12MON:
IF HELAST3 = 1 OR 2 OR HERECDK = 1 OR 2 OR HERECRE = 1 OR 2, THEN
HER12MON = 1
ELSE HER12MON = 2
DEFINE HAL12MON:
IF HALLREC = 1 OR 2, THEN HAL12MON = 1
ELSE HAL12MON = 2
DEFINE INH12MON:
IF INLAST = 1 OR 2 OR INRECDK = 1 OR 2 OR INRECRE = 1 OR 2, THEN
INH12MON = 1
ELSE INH12MON = 2
DEFINE MET12MON:
IF MELAST3 = 1 OR 2 OR MERECDK = 1 OR 2 OR MERECRE = 1 OR 2 , THEN
MET12MON = 1
ELSE MET12MON = 2
Checkpoint1
IF RXDrugs=1 OR (ALC12MON = 4 AND MAR12MON = 4 AND COC12MON = 2
AND HER12MON = 2 AND HAL12MON=2 AND INH12MON=2 AND MET12MON
= 2), GO TO INTROPR.
ELSE GO TO SUBSTANCE ABUSE MODULE
Pain Relievers Screener
INTROPR
These next questions are about any use of prescription pain relievers. Please do
not include “over-the-counter” pain relievers such as aspirin, Tylenol, Advil, or
Aleve.
To indicate that you have not used any of the pain relievers asked about in a
question, enter 95.
Press [ENTER] to continue.
PR01
Please look at the names and pictures of the pain relievers shown below. Please
note that some forms of these pain relievers may look different from the pictures,
but you should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR VICODIN, LORTAB,
NORCO, ZOHYDRO ER, AND HYDROCODONE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Vicodin
2
Lortab
3
Norco
4
Zohydro ER
5
Hydrocodone (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
4, OR 5.
PR02
Please look at the names and pictures of the pain relievers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR OXYCONTIN, PERCOCET,
AND PERCODAN.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
OxyContin
2
Percocet
3
Percodan
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
PR03
Please look at the names and pictures of the pain relievers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR ROXICODONE, AND
OXYCODONE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Roxicodone
2
Oxycodone (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, OR
2.
PRCC01
[IF ((PR01 = 1 AND PR02 = 1 AND PR03 = 1) OR (PR01 =2 AND PR02 = 2
AND PR03 = 2)) AND (# of responses in PR01 = 1) AND (# of responses in
PR02 = 1) AND (# of responses in PR03 = 1)] The computer recorded that you
used the following pain relievers in the past 12 months:
[PR01 FILL]
[PR02 FILL]
and [PR03 FILL]
Are all of these correct?
4
6
Yes
No
DK/REF
HARD ERROR: [IF PRCC01 = 6] Remember, please enter 95 if you have not used any of
the pain relievers asked about in the past 12 months. Please press the
[ENTER] key to return to these questions so that you can revise your
answers.
PR04
Please look at the names and pictures of the pain relievers shown below.
Remember, some forms of these pain relievers may look different from the
pictures, but you should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR ULTRAM, ULTRAM ER,
ULTRACET, TRAMADOL, AND EXTENDED-RELEASE TRAMADOL.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Ultram
2
Ultram ER
3
Ultracet
4
Tramadol (generic)
5
Extended-release tramadol (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
4, OR 5.
PR05
Please look at the names and pictures of the pain relievers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR TYLENOL WITH CODEINE
3 OR 4 AND CODEINE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
2
Tylenol with codeine 3 or 4 (NOT over-the-counter Tylenol)
Codeine pills (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1 OR 2.
PR06
Please look at the names and pictures of the pain relievers shown below.
Remember, some forms of these pain relievers may look different from the
pictures, but you should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR AVINZA, KADIAN, MS
CONTIN, MORPHINE, AND EXTENDED-RELEASE MORPHINE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Avinza
2
Kadian
3
MS Contin
4
Morphine (generic)
5
Extended-release morphine (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
4, OR 5.
PR07
Please look at the names and pictures of the pain relievers shown below.
Remember, some forms of these pain relievers may look different from the
pictures, but you should include any form that you have used.
PROGRAMMER: DISPLAY IMAGES HERE FOR DURAGESIC, FENTORA,
AND FENTANYL.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Duragesic
2
Fentora
3
Fentanyl (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
PR08
Please look at the names and pictures of the pain relievers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR SUBOXONE AND
BUPRENORPHINE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Suboxone
2
Buprenorphine (generic)
3
Buprenorphine plus naloxone (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
PR09
Please look at the names and pictures of the pain relievers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR OPANA, OPANA ER,
OXYMORPHONE, AND EXTENDED-RELEASE OXYMORPHONE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Opana
2
Opana ER
3
Oxymorphone (generic)
4
Extended-release oxymorphone (generic)
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
PR10
Please look at the names and pictures of the pain relievers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR DEMEROL, DILAUDID OR
HYDROMORPHONE, EXALGO OR EXTENDED-RELEASE
HYDROMORPHONE, AND METHADONE.
In the past 12 months, which, if any, of these pain relievers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Demerol
2
Dilaudid or hydromorphone
3
Exalgo or extended-release hydromorphone
4
Methadone
95
I have not used any of these pain relievers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
PRANYOTH
In the past 12 months, have you used any other prescription pain
reliever?
Remember, do not include “over-the-counter” pain relievers such as
aspirin, Tylenol, Advil, or Aleve.
SHOW 12-MONTH CALENDAR ON SCREEN.
1
Yes
2
No
DK/REF
DEFINE PR12MON:
IF (PR01 NE 95 OR DK/REF) OR (PR02 NE 95 OR DK/REF) OR (PR03 NE 95 OR DK/REF)
OR (PR04 NE 95 OR DK/REF) OR (PR05 NE 95 OR DK/REF) OR (PR06 NE 95 OR DK/REF)
OR (PR07 NE 95 OR DK/REF) OR (PR08 NE 95 OR DK/REF) OR (PR09 NE 95 OR DK/REF)
OR (PR10 NE 95 OR DK/REF) OR (PRANYOTH = 1) THEN PR12MON = 1.
ELSE PR12MON = 2.
DEFINE PRYRCOUNT:
INITIALIZE PRYRCOUNT TO 0.
ADD 1 TO PRYRCOUNT FOR EACH INDIVIDUAL DRUG SELECTED IN PR01PRANYOTH.
PRLANY
[IF PR12MON = 2] Have you ever, even once, used any prescription pain
reliever?
Remember, do not include “over-the-counter” pain relievers such as aspirin,
Tylenol, Advil, or Aleve.
1
Yes
2
No
DK/REF
Tranquilizers Screener
INTROTR
These next questions are about any use of prescription tranquilizers.
Tranquilizers are usually prescribed to relax people, to calm people down, to
relieve anxiety, or to relax muscle spasms. Some people call tranquilizers “nerve
pills.”
To indicate that you have not used any of the tranquilizers asked about in a
question, enter 95.
Press [ENTER] to continue.
TR01
Please look at the names and pictures of the tranquilizers shown below. Please
note that some forms of these tranquilizers may look different from the pictures,
but you should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR XANAX, XANAX XR,
ALPRAZOLAM, AND EXTENDED-RELEASE ALPRAZOLAM.
In the past 12 months, which, if any, of these tranquilizers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Xanax
2
Xanax XR
3
Alprazolam (generic)
4
Extended-release alprazolam (generic)
95
I have not used any of these tranquilizers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
TR02
Please look at the names and pictures of the tranquilizers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR ATIVAN, KLONOPIN,
LORAZEPAM, AND CLONAZEPAM.
In the past 12 months, which, if any, of these tranquilizers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Ativan
2
Klonopin
3
Lorazepam (generic)
4
Clonazepam (generic)
95
I have not used any of these tranquilizers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
TR03
Please look at the names and pictures of the tranquilizers shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR VALIUM AND
DIAZPEPAM.
In the past 12 months, which, if any, of these tranquilizers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Valium
2
Diazepam (generic)
95
I have not used any of these tranquilizers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1 OR 2.
TRCC01
[IF ((TR01 = 1 AND TR02 = 1 AND TR03 = 1) OR (TR01 =2 AND TR02 = 2
AND TR03 = 2)) AND (# of responses in TR01 = 1) AND (# of responses in
TR02 = 1) AND (# of responses in TR03 = 1)] The computer recorded that you
used the following tranquilizers in the past 12 months:
[TR01 FILL]
[TR02 FILL]
and [TR03 FILL]
Are all of these correct?
4
Yes
6
No
DK/REF
HARD ERROR: [IF TRCC01 = 6] Remember, please enter 95 if you have
not used any of the tranquilizers asked about in the past 12 months. Please
press the [ENTER] key to return to these questions so that you can revise
your answers.
TR04
Please look at the names and pictures of the tranquilizers shown below.
Remember, some forms of these tranquilizers may look different from the
pictures, but you should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR CYCLOBENZAPRINE AND
SOMA.
In the past 12 months, which, if any, of these tranquilizers have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Cyclobenzaprine (generic), also known as Flexeril
2
Soma
95
I have not used any of these tranquilizers in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1 OR 2.
TRANYOTH
In the past 12 months, have you used any other prescription tranquilizer?
SHOW 12-MONTH CALENDAR ON SCREEN.
1
Yes
2
No
DK/REF
DEFINE TR12MON:
IF (TR01 NE 95 OR DK/REF) OR (TR02 NE 95 OR DK/REF) OR (TR03 NE 95 OR DK/REF)
OR (TR04 NE 95 OR DK/REF) OR (TRANYOTH = 1) THEN TR12MON = 1.
ELSE TR12MON = 2.
DEFINE TRYRCOUNT:
INITIALIZE TRYRCOUNT TO 0.
ADD 1 TO TRYRCOUNT FOR EACH INDIVIDUAL DRUG SELECTED IN TR01TRANYOTH.
TRLANY
[IF TR12MON = 2] Have you ever, even once, used any prescription
tranquilizer?
1
Yes
2
No
DK/REF
Stimulants Screener
INTROST
These next questions are about any use of prescription stimulants. People
sometimes take these drugs for attention deficit disorders, to lose weight, or to
stay awake. Please do not include “over-the-counter” stimulants such as
Dexatrim, No-Doz, Hydroxycut, or 5-Hour Energy.
To indicate that you have not used any of the stimulants asked about in a
question, enter 95.
Press [ENTER] to continue.
ST01
Please look at the names and pictures of the stimulants shown below. Please note
that some forms of these stimulants may look different from the pictures, but you
should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR ADDERALL, ADDERALL
XR, AND DEXEDRINE.
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Adderall
2
Adderall XR
3
Dexedrine
95
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
ST02
Please look at the names and pictures of the stimulants shown below.
PROGRAMMER: DISPLAY PILLS HERE FOR DEXTROAMPHETAMINE,
AMPHETAMINE-DEXTROAMPHETAMINE MIX, AND EXTENDEDRELEASE AMPHETAMINE-DEXTROAMPHETAMINE MIX.
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
2
Dextroamphetamine (generic)
Mixed amphetamine-dextroamphetamine pills other than Adderall
(generic)
3
Extended-release amphetamine-dextroamphetamine pills other than
Adderall XR (generic)
95
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
ST03
Please look at the names and pictures of the stimulants shown below.
PROGRAMMER: DISPLAY IMAGES FOR RITALIN, RITALIN LA,
CONCERTA, AND DAYTRANA. (DAYTRANA IS A PATCH.)
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Ritalin
2
Ritalin LA
3
Concerta
4
Daytrana
95
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
STCC01
[IF ((ST01 = 1 AND ST02 = 1 AND ST03 = 1) OR (ST01 =2 AND ST02 = 2
AND ST03 = 2)) AND (# of responses in ST01 = 1) AND (# of responses in
ST02 = 1) AND (# of responses in ST03 = 1)] The computer recorded that you
used the following stimulants in the past 12 months:
[ST01 FILL]
[ST02 FILL]
and [ST03 FILL]
Are all of these correct?
4
6
Yes
No
DK/REF
HARD ERROR: [IF STCC01 = 6] Remember, please enter 95 if you have not used any of
the stimulants asked about in the past 12 months. Please press the [ENTER] key to return
to these questions so that you can revise your answers.
ST04
Please look at the names and pictures of the stimulants shown below.
PROGRAMMER: DISPLAY PILLS FOR METADATE CD, METADATE ER,
METHYLPHENIDATE, AND EXTENDED-RELEASE
METHYLPHENIDATE.
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Metadate CD
2
Metadate ER
3
Methylphenidate (generic)
4
Extended-release methylphenidate (generic)
95
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
ST05
Please look at the names and pictures of the stimulants shown below.
PROGRAMMER: DISPLAY PILLS FOR FOCALIN, FOCALIN XR,
DEXMETHYLPHENIDATE, AND EXTENDED-RELEASE
DEXMETHYLPHENIDATE.
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
2
3
4
95
Focalin
Focalin XR
Dexmethylphenidate (generic)
Extended-release dexmethylphenidate (generic)
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
ST06
Please look at the names and pictures of the stimulants shown below.
PROGRAMMER: DISPLAY PILLS FOR BENZPHETAMINE, DIDREX,
DIETHYLPROPION, PHENDIMETRAZINE, AND PHENTERMINE.
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Benzphetamine
2
Didrex
3
Diethylpropion
4
Phendimetrazine
5
Phentermine
95
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
4, OR 5.
ST07
Please look at the names and pictures of the stimulants shown below.
PROGRAMMER: DISPLAY PILLS FOR PROVIGIL, TENUATE, AND
VYVANSE.
In the past 12 months, which, if any, of these stimulants have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Provigil
2
Tenuate
3
Vyvanse
95
I have not used any of these stimulants in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
STANYOTH
In the past 12 months, have you used any other prescription stimulant?
Remember, do not include “over-the-counter” stimulants such as
Dexatrim, No-Doz, Hydroxycut, or 5-Hour Energy.
SHOW 12-MONTH CALENDAR ON SCREEN.
1
Yes
2
No
DK/REF
DEFINE ST12MON:
IF (ST01 NE 95 OR DK/REF) OR (ST02 NE 95 OR DK/REF) OR (ST03 NE 95 OR DK/REF)
OR (ST04 NE 95 OR DK/REF) OR (ST05 NE 95 OR DK/REF) OR (ST06 NE 95 OR DK/REF)
OR (ST07 NE 95 OR DK/REF) OR (STANYOTH = 1) THEN ST12MON = 1.
ELSE ST12MON = 2.
DEFINE STYRCOUNT:
INITIALIZE STYRCOUNT TO 0.
ADD 1 TO STYRCOUNT FOR EACH INDIVIDUAL DRUG SELECTED IN ST01STANYOTH.
STLANY
[IF ST12MON = 2] Have you ever, even once, used any prescription stimulant?
Remember, do not include “over-the-counter” stimulants such as Dexatrim, NoDoz, Hydroxycut, or 5-Hour Energy.
1
Yes
2
No
DK/REF
Sedatives Screener
INTROSV
These next questions ask about any use of prescription sedatives or
barbiturates. These drugs are also called “downers” or “sleeping pills.” People
take these drugs to help them relax or help them sleep. Please do not include
“over-the-counter” sedatives such as Sominex, Unisom, Nytol, or Benadryl.
To indicate that you have not used any of the sedatives asked about in a question,
enter 95.
Press [ENTER] to continue.
SV01
Please look at the names and pictures of the sedatives shown below. Please note
that some forms of these sedatives may look different from the pictures, but you
should include any form that you have used.
PROGRAMMER: DISPLAY PILLS HERE FOR AMBIEN, AMBIEN CR,
ZOLPIDEM, AND EXTENDED-RELEASE ZOLPIDEM.
In the past 12 months, which, if any, of these sedatives have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Ambien
2
Ambien CR
3
Zolpidem (generic)
4
Extended-release zolpidem (generic)
95
I have not used any of these sedatives in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
OR 4.
SV02
Please look at the names and pictures of the sedatives shown below.
PROGRAMMER: DISPLAY IMAGES FOR LUNESTA, SONATA, AND
ZALEPLON.
In the past 12 months, which, if any, of these sedatives have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Lunesta or eszopiclone
2
Sonata or zaleplon
95
I have not used any of these sedatives in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1 OR 2.
SV03
Please look at the names and pictures of the sedatives shown below.
PROGRAMMER: DISPLAY PILLS FOR HALCION, RESTORIL,
FLURAZEPAM, TEMAZEPAM, AND TRIAZOLAM.
In the past 12 months, which, if any, of these sedatives have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Halcion
2
Restoril
3
Flurazepam (generic), also known as Dalmane
4
Temazepam (generic)
5
Triazolam (generic)
95
I have not used any of these sedatives in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2, 3,
4, OR 5.
SVCC01
[IF ((SV01 = 1 AND SV02 = 1 AND SV03 = 1) OR (SV01 =2 AND SV02 = 2
AND SV03 = 2)) AND (# of responses in SV01 = 1) AND (# of responses in
SV02 = 1) AND (# of responses in SV03 = 1)] The computer recorded that you
used the following sedatives in the past 12 months:
[SV01 FILL]
[SV02 FILL]
and [SV03 FILL]
Are all of these correct?
4
6
Yes
No
DK/REF
HARD ERROR: [IF SVCC01 = 6] Remember, please enter 95 if you have not
used any of the sedatives asked about in the past 12 months. Please press the
[ENTER] key to return to these questions so that you can revise your
answers.
SV04
Please look at the names and pictures of the sedatives shown below.
PROGRAMMER: DISPLAY PILLS FOR BUTISOL, SECONAL, AND
PHENOBARBITAL.
In the past 12 months, which, if any, of these sedatives have you used?
To select more than one drug from the list, press the space bar between each
number you have typed. When you have finished, press [ENTER].
1
Butisol
2
Seconal
3
Phenobarbital (generic)
95
I have not used any of these sedatives in the past 12 months
DK/REF
DO NOT ALLOW 95 IN COMBINATION WITH ANY RESPONSE OF 1, 2,
OR 3.
SVANYOTH
In the past 12 months, have you used any other prescription sedative?
Remember, do not include “over-the-counter” sedatives such as Sominex,
Unisom, Nytol, or Benadryl.
SHOW 12-MONTH CALENDAR ON SCREEN.
1
Yes
2
No
DK/REF
DEFINE SV12MON:
IF (SV01 NE 95 OR DK/REF) OR (SV02 NE 95 OR DK/REF) OR (SV03 NE 95 OR DK/REF)
OR (SV04 NE 95 OR DK/REF) OR (SVANYOTH = 1) THEN SV12MON = 1.
ELSE SV12MON = 2.
DEFINE SVYRCOUNT:
INITIALIZE SVYRCOUNT TO 0.
ADD 1 TO SVYRCOUNT FOR EACH INDIVIDUAL DRUG SELECTED IN SV01SVANYOTH.
SVLANY
[IF SV12MON = 2] Have you ever, even once, used any prescription sedative?
Remember, do not include “over-the-counter” sedatives such as Sominex,
Unisom, Nytol, or Benadryl.
1
Yes
2
No
DK/REF
Pain Relievers Main Module
If no 12 month use of prescription pain relievers:
PRINTROLIF
[IF PRLANY = 1] The next question asks about using prescription pain
relievers in any way a doctor did not direct you to use them.
When you answer this question, please think only about your use of the drug
in any way a doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to
take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
PRL01
[IF PRLANY=1] Have you ever, even once, used any prescription pain
reliever in any way a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
If any 12 month use of prescription pain relievers:
PRINTROYR1 [IF PR12MON = 1] Earlier you reported having used certain prescription pain
relievers during the past year. Now please think about whether you used any of these pain
relievers in any way a doctor did not direct you to use them.
When you answer these questions, please think only about your use of the drug in any way a
doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
DEFINE PRFILL:
PRFILL LISTS ALL INDIVIDUAL DRUGS SELECTED IN PR01, PR02, PR03, PR04, PR05,
PR06, PR07, PR08, PR09, AND PR10.
USE MULTIPLE COLUMNS AS NEEDED. PRECEDE LAST ITEM WITH “and”. IF
PRANYOTH=1 AND PRYRCOUNT > 1, THEN ADD “another prescription pain reliever” TO
THE FILL.
THE FOLLOWING DRUGS SHOULD NOT USE INITIAL CAPS WHEN FILLED IN
SENTENCE FORMAT:
hydrocodone
oxycodone
propoxyphene
tramadol
extended-release tramadol
codeine pills
morphine
extended-release morphine
fentanyl
buprenorphine
oxymorphone
extended-release oxymorphone
hydromorphone
extended-release hydromorphone
methadone
WHEN IMPLEMENTING PRFILL, IF 1, OR 2 DRUGS APPEAR IN LIST, FILL IN
SENTENCE FORMAT, SEPARATED WITH AN “and” BEFORE THE LAST FILL.
IF >2 DRUGS APPEAR IN LIST, FILL IN LIST (IN COLUMNS IF NEEDED) BELOW THE
PREVIOUS SENTENCE.
DEFINE PRFIRSTFLAG:
PRFIRSTFLAG IDENTIFIES THE FIRST PAIN RELIEVER USED NONMEDICALLY.
INITIALIZE PRFIRSTFLAG TO 0.
(PRFIRSTFLAG NEEDS TO BE DEFINED BEFORE THE ROUTING TO PRINTROYR2 OR
PRYOTH.)
PRINTROYR2 [IF PR12MON=1 AND (PRANYOTH NE 1 OR (PRANYOTH=1 AND
PRYRCOUNT > 1))] Earlier, the computer recorded that, in the past 12 months, you used
[PRFILL].
Press Enter to continue.
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE FOR
THE INTRO SCREEN
PRY01 [IF PR01=1] In the past 12 months, did you use Vicodin in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR VICODIN
1
Yes
2
No
DK/REF
PRY02 [IF PR01=2] In the past 12 months, did you use Lortab in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR LORTAB
1
Yes
2
No
DK/REF
PRY03 [IF PR01=3] In the past 12 months, did you use Norco in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR NORCO
1
Yes
2
No
DK/REF
PRY04 [IF PR01=4] In the past 12 months, did you use Zohydro ER in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR ZOHYDRO ER
1
Yes
2
No
DK/REF
PRY05 [IF PR01=5] In the past 12 months, did you use hydrocodone in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
PRY06 [IF PR02=1] In the past 12 months, did you use OxyContin in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR OXYCONTIN
1
Yes
2
No
DK/REF
PRY07 [IF PR02=2] In the past 12 months, did you use Percocet in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR PERCOCET
1
Yes
2
No
DK/REF
PRY08 [IF PR02=3] In the past 12 months, did you use Percodan in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR PERCODAN
1
Yes
2
No
DK/REF
PRY09 [IF PR03=1] In the past 12 months, did you use Roxicet in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ROXICET
1
Yes
2
No
DK/REF
PRY10 [IF PR03=2] In the past 12 months, did you use Roxicodone in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR ROXICODONE
1
Yes
2
No
DK/REF
PRY11 [IF PR03=] In the past 12 months, did you use oxycodone in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR OXYCODONE
1
Yes
2
No
DK/REF
PRY12 [IF PR04=1] In the past 12 months, did you use Ultram in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ULTRAM
1
Yes
2
No
DK/REF
PRY13 [IF PR04=2] In the past 12 months, did you use Ultram ER in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ULTRAM ER
1
Yes
2
No
DK/REF
PRY14 [IF PR04=3] In the past 12 months, did you use Ultracet in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ULTRACET
1
Yes
2
No
DK/REF
PRY15 [IF PR04=4] In the past 12 months, did you use tramadol in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR TRAMADOL
1
2
Yes
No
DK/REF
PRY16 [IF PR04=5] In the past 12 months, did you use extended-release tramadol in any way a
doctor did not direct you to use it?
DISPLAY IMAGE FOR EXTENDED-RELEASE TRAMADOL (GENERIC)
1
Yes
2
No
DK/REF
PRY17 [IF PR05=1] In the past 12 months, did you use Tylenol with codeine 3 or 4 in any way
a doctor did not direct you to use it?
DISPLAY IMAGE FOR TYLENOL WITH CODEINE
1
Yes
2
No
DK/REF
PRY18 [IF PR05=2] In the past 12 months, did you use codeine pills in any way a doctor did
not direct you to use them?
DISPLAY IMAGE FOR CODEINE
1
Yes
2
No
DK/REF
PRY19 [IF PR06=1] In the past 12 months, did you use Avinza in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR AVINZA
1
Yes
2
No
DK/REF
PRY20 [IF PR06=2] In the past 12 months, did you use Kadian in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR KADIAN
1
Yes
2
No
DK/REF
PRY21 [IF PR06=3] In the past 12 months, did you use MS Contin in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR MS CONTIN
1
Yes
2
No
DK/REF
PRY22 [IF PR06=4] In the past 12 months, did you use morphine in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR MORPHINE
1
Yes
2
No
DK/REF
PRY23 [IF PR06=5] In the past 12 months, did you use extended-release morphine in any way a
doctor did not direct you to use it?
DISPLAY IMAGE FOR EXTENDED-RELEASE MORPHINE (GENERIC)
1
Yes
2
No
DK/REF
PRY24 [IF PR07=1] In the past 12 months, did you use Actiq in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ACTIQ
1
Yes
2
No
DK/REF
PRY25 [IF PR07=2] In the past 12 months, did you use Duragesic in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR DURAGESIC
1
Yes
2
No
DK/REF
PRY26 [IF PR07=3] In the past 12 months, did you use Fentora in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR FENTORA
1
Yes
2
No
DK/REF
PRY27 [IF PR07=4] In the past 12 months, did you use fentanyl in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR FENTANYL
1
Yes
2
No
DK/REF
PRY28 [IF PR08=1] In the past 12 months, did you use Suboxone in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR SUBOXONE
1
Yes
2
No
DK/REF
PRY29 [IF PR08=2] In the past 12 months, did you use buprenorphine in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR BUPRENORPHINE
1
Yes
2
No
DK/REF
PRY30 [IF PR09=1] In the past 12 months, did you use Opana in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR OPANA
1
Yes
2
No
DK/REF
PRY31 [IF PR09=2] In the past 12 months, did you use Opana ER in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR OPANA ER
1
Yes
2
No
DK/REF
PRY32 [IF PR09=3] In the past 12 months, did you use oxymorphone in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR OXYMORPHONE (GENERIC)
1
Yes
2
No
DK/REF
PRY33 [IF PR09=4] In the past 12 months, did you use extended-release oxymorphone in any
way a doctor did not direct you to use it?
DISPLAY IMAGE FOR EXTENDED-RELEASE OXYMORPHONE (GENERIC)
1
Yes
2
No
DK/REF
PRY34 [IF PR10=1] In the past 12 months, did you use Demerol in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR DEMEROL
1
Yes
2
No
DK/REF
PRY35 [IF PR10=2] In the past 12 months, did you use Dilaudid or hydromorphone in any way
a doctor did not direct you to use it?
DISPLAY IMAGE FOR DILAUDID OR HYDROMORPHONE
1
Yes
2
No
DK/REF
PRY36 [IF PR10=3] In the past 12 months, did you use Exalgo or extended-release
hydromorphone in any way a doctor did not direct you to use it?
DISPLAY IMAGE FOR EXALGO OR EXTENDED-RELEASE HYDROMORPHONE
1
Yes
2
No
DK/REF
PRY37 [IF PR10=4] In the past 12 months, did you use methadone in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR METHADONE
1
Yes
2
No
DK/REF
PRYOTH [IF PRANYOTH=1] In the past 12 months, did you use any [IF PRANYOTH=1
AND PRYRCOUNT > 1 FILL “other”] prescription pain reliever in a way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE
DEFINE PRMISCOUNT:
INITIALIZE PRMISCOUNT TO 0.
INCREMENT PRMISCOUNT BY 1 FOR EVERY RESPONSE OF YES IN PRY01- PRYOTH.
DEFINE PRNUMFILL:
IF PRMISCOUNT = 1 AND PRY17 NE 1 AND PRYOTH NE 1 THEN PRNUMFILL = "it".
ELSE PRNUMFILL = "them".
DEFINE PRFILL2:
IF PRMISCOUNT < 3 AND PRYOTH NE 1 AND PRDKREFFLAG =2 THEN
PRFILL2=”[DRUG NAMES FROM PRY01-PRY36]”.
ELSE IF PRMISCOUNT=1 AND PRYOTH NE 1 AND PRDKREFFLAG=1 THEN PRFILL2 =
“[DRUG NAMES FROM PRY01-PRY36] or any other prescription pain reliever.” ELSE IF
PRMISCOUNT=2 AND PRDKREFFLAG=2 AND PRYOTH =1 THEN PRFILL2=”[DRUG
NAME FROM PRY01-PRY36] and some other prescription pain reliever.”
ELSE IF PRMISCOUNT=2 AND PRDKREFFLAG=1 THEN PRFILL2=”[DRUG NAMES
FROM PRY01-PRY36]”. IF PRYOTH =1 THEN ADD “some other prescription pain reliever”
TO THE FILL. [INCLUDE DRUG NAMES FOR NEW PAIN RELIEVERS.]
ELSE PRFILL2= “prescription pain relievers”
Tranquilizers Main Module
If no 12 month use of prescription tranquilizers:
TRINTROLIF
[IF TRLANY = 1] The next question asks about using prescription
tranquilizers in any way a doctor did not direct you to use them.
When you answer this question, please think only about your use of the drug
in any way a doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to
take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
TRL01
[IF TRLANY =1] Have you ever, even once, used any prescription
tranquilizer in any way a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
If any 12 month use of prescription tranquilizers:
TRINTROYR1 [IF TR12MON = 1] The next questions ask about using prescription
tranquilizers in any way a doctor did not direct you to use them.
When you answer these questions, please think only about your use of the drug in any way a
doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
DEFINE TRFILL:
TRFILL LISTS ALL INDIVIDUAL DRUGS SELECTED IN TR01, TR02, TR03, TR04, AND
TR05.
USE MULTIPLE COLUMNS AS NEEDED. IF TRANYOTH =1 AND TRYRCOUNT > 1,
THEN ADD “another prescription tranquilizer” TO THE FILL.
THE FOLLOWING DRUGS SHOULD NOT USE INITIAL CAPS WHEN FILLED IN
SENTENCE FORMAT:
alprazolam
extended-release alprazolam
lorazepam
clonazepam
diazepam
cyclobenzaprine, also known as Flexeril
buspirone also known as BuSpar
hydroxyzine also known as Atarax or Vistaril
meprobamate also known as Equanil or Miltown
WHEN IMPLEMENTING TRFILL, IF 1, OR 2 DRUGS APPEAR IN LIST, FILL IN
SENTENCE FORMAT, SEPARATED WITH AN “and” BEFORE THE LAST FILL.
IF >2 DRUGS APPEAR IN LIST, FILL IN LIST (IN COLUMNS IF NEEDED) BELOW THE
PREVIOUS SENTENCE.
DEFINE TRFIRSTFLAG:
TRFIRSTFLAG IDENTIFIES THE FIRST SEDATIVE USED NONMEDICALLY.
INITIALIZE TRFIRSTFLAG TO 0.
(TRFIRSTFLAG NEEDS TO BE DEFINED BEFORE THE ROUTING TO TRINTROYR2 OR
TRY40.)
TRINTROYR2 [IF TR12MON=1 AND (TRANYOTH NE 1 OR (TRANYOTH =1 AND
TRYRCOUNT > 1))] Earlier, the computer recorded that, in the past 12 months, you used
[TRFILL].
Press Enter to continue.
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE FOR THE
INTRO SCREEN
TRY01 [IF TR01=1] In the past 12 months, did you use Xanax in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR XANAX
1
Yes
2
No
DK/REF
TRY02 [IF TR01=2] In the past 12 months, did you use Xanax XR in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR XANAX XR
1
Yes
2
No
DK/REF
TRY03 [IF TR01=3] In the past 12 months, did you use alprazolam in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ALPRAZOLAM
1
Yes
2
No
DK/REF
TRY04 [IF TR01=4] In the past 12 months, did you use extended-release alprazolam in any way
a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
TRY05 [IF TR02=1] In the past 12 months, did you use Ativan in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ATIVAN
1
Yes
2
No
DK/REF
TRY06 [IF TR02=2] In the past 12 months, did you use Klonopin in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR KLONOPIN
1
Yes
2
No
DK/REF
TRY07 [IF TR02=3] In the past 12 months, did you use lorazepam in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR LORAZEPAM
1
Yes
2
No
DK/REF
TRY08 [IF TR02=4] In the past 12 months, did you use clonazepam in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR CLONAZEPAM
1
Yes
2
No
DK/REF
TRY09 [IF TR03=1] In the past 12 months, did you use Valium in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR VALIUM
1
Yes
2
No
DK/REF
TRY10 [IF TR03=2] In the past 12 months, did you use diazepam in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR DIAZEPAM
1
Yes
2
No
DK/REF
TRY11 [IF TR04=1] In the past 12 months, did you use cyclobenzaprine, also known as
Flexeril, in any way a doctor did not direct you to use it?
DISPLAY IMAGE FOR CYCLOBENZAPRINE
1
Yes
2
No
DK/REF
TRY12 [IF TR04=2] In the past 12 months, did you use Soma in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR SOMA
1
Yes
2
No
DK/REF
TRY13 [IF TR05=1] In the past 12 months, did you use buspirone, also known as BuSpar, in
any way a doctor did not direct you to use it?
DISPLAY IMAGE FOR BUSPIRONE, ALSO KNOWN AS BUSPAR,
1
Yes
2
No
DK/REF
UPDATE TRFIRSTFLAG:
IF TRFIRSTFLAG=0 AND TRY13=1 THEN TRFIRSTFLAG=13.
TRY14 [IF TR05=2] In the past 12 months, did you use hydroxyzine, also known as Atarax or
Vistaril, in any way a doctor did not direct you to use it?
DISPLAY IMAGE FOR HYDROXYZINE
1
Yes
2
No
DK/REF
TRY15 [IF TR05=3] In the past 12 months, did you use meprobamate, also known as Equanil or
Miltown, in any way a doctor did not direct you to use it?
DISPLAY IMAGE FOR MEPROBAMATE
1
Yes
2
No
DK/REF
TRYOTH [IF TRANYOTH =1] In the past 12 months, did you use any [IF TRANYOTH =1
AND TRYRCOUNT > 1 FILL “other”] prescription tranquilizer in a way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE
DEFINE TRMISCOUNT:
INITIALIZE TRMISCOUNT TO 0.
INCREMENT TRMISCOUNT BY 1 FOR EVERY RESPONSE OF YES IN TRY01-TRYOTH.
DEFINE TRFILL2:
IF TRMISCOUNT < 3 AND TRYOTH NE 1 AND TRDKREFFLAG =2 THEN
TRFILL2=”[DRUG NAMES FROM TRY01- TRY12]”.
ELSE IF TRMISCOUNT=1 AND TRYOTH NE 1 AND TRDKREFFLAG=1 THEN TRFILL2
= “[DRUG NAMES FROM TRY01- TRY12] or any other prescription tranquilizer.”
ELSE IF TRMISCOUNT=2 AND TRDKREFFLAG=2 AND TRYOTH =1 THEN
TRFILL2=”[DRUG NAME FROM TRY01- TRY12] and some other prescription tranquilizer.”
ELSE IF TRMISCOUNT=2 AND TRDKREFFLAG=1 THEN TRFILL2=”[DRUG NAMES
FROM TRY01- TRY12]”. IF TRYOTH =1 THEN ADD “some other prescription tranquilizer”
TO THE FILL.
ELSE TRFILL2= “prescription tranquilizers”
Stimulants Main Module
If no 12 month use of prescription stimulants:
STINTROLIF
[IF STLANY = 1] The next question asks about using prescription
stimulants in any way a doctor did not direct you to use them.
When you answer this question, please think only about your use of the drug
in any way a doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to
take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
STL01
[IF STLANY =1] Have you ever, even once, used any prescription stimulant in
any way a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
If any 12 month use of prescription stimulants:
STINTROYR1 [IF ST12MON = 1] The next questions ask about using prescription
stimulants in any way a doctor did not direct you to use them.
When you answer these questions, please think only about your use of the drug in any way a
doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
DEFINE STFILL:
STFILL LISTS ALL INDIVIDUAL DRUGS SELECTED IN ST01, ST02, ST03, ST04, ST05,
ST06, AND ST07.
USE MULTIPLE COLUMNS AS NEEDED. IF STANYOTH =1 AND STYRCOUNT > 1
THEN ADD “another prescription stimulant” TO THE FILL.
THE FOLLOWING DRUGS SHOULD NOT USE INITIAL CAPS WHEN FILLED IN
SENTENCE FORMAT:
dextroamphetamine
mixed amphetamine-dextroamphetamine pills
extended-release amphetamine-dextroamphetamine pills
methylphenidate
extended-release methylphenidate
dexmethylphenidate
extended-release dexmethylphenidate
benzphetamine
diethylpropion
phendimetrazine
phentermine
WHEN IMPLEMENTING STFILL, IF 1 OR 2 DRUGS APPEAR IN LIST, FILL IN
SENTENCE FORMAT, SEPARATED BY AN “and” BEFORE THE LAST FILL.
IF >2 DRUGS APPEAR IN LIST, FILL IN LIST (IN COLUMNS IF NEEDED) BELOW THE
PREVIOUS SENTENCE.
DEFINE STFIRSTFLAG:
STFIRSTFLAG IDENTIFIES THE FIRST STIMULANT USED NONMEDICALLY.
INITIALIZE STFIRSTFLAG TO 0.
STINTROYR2 [IF ST12MON=1 AND STYRCOUNT > 0 AND (STANYOTH NE 1 OR
(STANYOTH =1 AND STYRCOUNT > 1))] Earlier, the computer recorded that, in the past 12
months, you used [STFILL].
Press Enter to continue.
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE FOR THE
INTRO SCREEN
STY01 [IF ST01=1] In the past 12 months, did you use Adderall in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ADDERALL
1
Yes
2
No
DK/REF
STY02 [IF ST01=2] In the past 12 months, did you use Adderall XR in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
STY03 [IF ST01=3] In the past 12 months, did you use Dexedrine in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY04 [IF ST02=1] In the past 12 months, did you use dextroamphetamine in any way a doctor
did not direct you to use it?
1
Yes
2
No
DK/REF
UPDATE STFIRSTFLAG:
IF STFIRSTFLAG=0 AND STY04=1 THEN STFIRSTFLAG=4.
STY04a [IF STFIRSTFLAG=4] Please think about the first time you ever used
dextroamphetamine in a way a doctor did not direct you to use it.
[IF STY04=1] How old were you when you first used dextroamphetamine in a way a doctor did
not direct you to use it?
AGE:
DK/REF
[(RANGE: 1 - 110)]
STY06 [IF ST02=3] In the past 12 months, did you use extended-release amphetaminedextroamphetamine pills in any way a doctor did not direct you to use them?
1
Yes
2
No
DK/REF
STY07 [IF ST03=1] In the past 12 months, did you use Ritalin in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY08 [IF ST03=2] In the past 12 months, did you use Ritalin SR or Ritalin LA in any way a
doctor did not direct you to use it?
1
Yes
2
No
DK/REF
STY09 [IF ST03=3] In the past 12 months, did you use Concerta in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY10 [IF ST03=4] In the past 12 months, did you use Daytrana in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY11 [IF ST04=1] In the past 12 months, did you use Metadate CD in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
STY12 [IF ST04=2] In the past 12 months, did you use Metadate ER in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
STY13 [IF ST04=3] In the past 12 months, did you use methylphenidate in any way a doctor
did not direct you to use it?
1
Yes
2
No
DK/REF
STY14 [IF ST04=4] In the past 12 months, did you use extended-release methylphenidate in any
way a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
STY15 [IF ST05=1] In the past 12 months, did you use Focalin in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY16 [IF ST05=2] In the past 12 months, did you use Focalin XR in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY17 [IF ST05=3] In the past 12 months, did you use dexmethylphenidate in any way a
doctor did not direct you to use it?
1
Yes
2
No
DK/REF
STY18 [IF ST05=4] In the past 12 months, did you use extended-release dexmethylphenidate in
any way a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
STY19 [IF ST06=1] In the past 12 months, did you use benzphetamine in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
STY20 [IF ST06=2] In the past 12 months, did you use Didrex in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY21 [IF ST06=3] In the past 12 months, did you use diethylpropion in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
STY22 [IF ST06=4] In the past 12 months, did you use phendimetrazine in any way a doctor
did not direct you to use it?
1
Yes
2
No
DK/REF
STY23 [IF ST06=5] In the past 12 months, did you use phentermine in any way a doctor did
not direct you to use it?
1
Yes
2
No
DK/REF
STY24 [IF ST07=1] In the past 12 months, did you use Provigil in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY25 [IF ST07=2] In the past 12 months, did you use Tenuate in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STY26 [IF ST07=3] In the past 12 months, did you use Vyvanse in any way a doctor did not
direct you to use it?
1
Yes
2
No
DK/REF
STYOTH [IF STANYOTH =1] In the past 12 months, did you use any [IF STANYOTH =1
AND STYRCOUNT > 1 FILL “other”] prescription stimulant in a way a doctor did not direct
you to use it?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE.
DEFINE STMISCOUNT:
INITIALIZE STMISCOUNT TO 0.
INCREMENT STMISCOUNT BY 1 FOR EVERY RESPONSE OF YES IN STY01- STYOTH.
DEFINE STFILL2:
IF STMISCOUNT < 3 AND STYOTH NE 1 AND STDKREFFLAG =2 THEN
STFILL2=”[DRUG NAMES FROM STY01-STY26]”.
ELSE IF STMISCOUNT=1 AND STYOTH NE 1 AND STDKREFFLAG=1 THEN STFILL2 =
“[DRUG NAMES FROM STY01- STY26] or any other prescription stimulant.”
ELSE IF STMISCOUNT=2 AND STDKREFFLAG=2 AND STYOTH=1 THEN
STFILL2=”[DRUG NAME FROM STY01-STY23] and some other prescription stimulant.”
ELSE IF STMISCOUNT=2 AND STDKREFFLAG=1 THEN STFILL2=”[DRUG NAMES
FROM STY01-STY26]”. IF STYOTH=1 THEN ADD “some other prescription stimulant” TO
THE FILL.
ELSE STFILL2= “prescription stimulants”
Sedatives Main Module
If no 12 month use of prescription sedatives:
SVINTROLIF
[IF SVLANY = 1] The next question asks about using prescription sedatives
in any way a doctor did not direct you to use them.
When you answer this question, please think only about your use of the drug
in any way a doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to
take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
SVL01
[IF SVLANY =1] Have you ever, even once, used any prescription sedative in
any way a doctor did not direct you to use it?
1
Yes
2
No
DK/REF
If any 12 month use of prescription sedatives:
SVINTROYR1 [IF SV12MON = 1] The next questions ask about using prescription sedatives
in any way a doctor did not direct you to use them.
When you answer these questions, please think only about your use of the drug in any way a
doctor did not direct you to use it, including:
Using it without a prescription of your own
Using it in greater amounts, more often, or longer than you were told to take it
Using it in any other way a doctor did not direct you to use it
Press Enter to continue.
DEFINE SVFILL:
SVFILL LISTS ALL INDIVIDUAL DRUGS SELECTED IN SV01, SV02, SV03, AND SV04.
USE MULTIPLE COLUMNS AS NEEDED. IF SVANYOTH =1 AND SVYRCOUNT > 1,
THEN ADD “another prescription sedative” TO THE FILL.
THE FOLLOWING DRUGS SHOULD NOT USE INITIAL CAPS WHEN FILLED IN
SENTENCE FORMAT:
zolpidem
extended-release zolpidem
eszopiclone
zaleplon
flurazepam
triazolam
temazepam
phenobarbital
WHEN IMPLEMENTING SVFILL, IF 1, OR 2 DRUGS APPEAR IN LIST, FILL IN
SENTENCE FORMAT, SEPARATED WITH AN “and” BEFORE THE LAST FILL.
IF >2 DRUGS APPEAR IN LIST, FILL IN LIST (IN COLUMNS IF NEEDED) BELOW THE
PREVIOUS SENTENCE.
DEFINE SVFIRSTFLAG:
SVFIRSTFLAG IDENTIFIES THE FIRST SEDATIVE USED NONMEDICALLY.
INITIALIZE SVFIRSTFLAG TO 0.
(SVFIRSTFLAG NEEDS TO BE DEFINED BEFORE THE ROUTING TO SVINTROYR2 OR
SVYOTH.)
SVINTROYR2 [IF SV12MON=1 AND (SVANYOTH NE 1 OR (SVANYOTH =1 AND
SVYRCOUNT > 1))] Earlier, the computer recorded that, in the past 12 months, you used
[SVFILL].
Press Enter to continue.
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE FOR THE
INTRO SCREEN
SVY01 [IF SV01=1] In the past 12 months, did you use Ambien in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR AMBIEN
1
Yes
2
No
DK/REF
SVY02 [IF SV01=2] In the past 12 months, did you use Ambien CR in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR AMBIEN CR
1
Yes
2
No
DK/REF
SVY03 [IF SV01=3] In the past 12 months, did you use zolpidem in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR ZOLPIDEM
1
2
Yes
No
DK/REF
SVY04 [IF SV01=4] In the past 12 months, did you use extended-release zolpidem in any way a
doctor did not direct you to use it?
1
Yes
2
No
DK/REF
SVY05 [IF SV02=1] In the past 12 months, did you use Lunesta or eszopiclone in any way a
doctor did not direct you to use it?
DISPLAY IMAGE FOR LUNESTA OR ESZOPICLONE
1
Yes
2
No
DK/REF
SVY06 [IF SV02=2] In the past 12 months, did you use Sonata or zaleplon in any way a doctor
did not direct you to use it?
DISPLAY IMAGE FOR SONATA OR ZALEPLON
1
Yes
2
No
DK/REF
SVY07 [IF SV03=1] In the past 12 months, did you use Halcion in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR HALCION
1
Yes
2
No
DK/REF
SVY08 [IF SV03=2] In the past 12 months, did you use Restoril in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR RESTORIL
1
Yes
2
No
DK/REF
SVY09 [IF SV03=3] In the past 12 months, did you use flurazepam, also known as Dalmane, in
any way a doctor did not direct you to use it?
DISPLAY IMAGE FOR FLURAZEPAM
1
Yes
2
No
DK/REF
SVY10 [IF SV03=4] In the past 12 months, did you use temazepam in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR TEMAZEPAM
1
Yes
2
No
DK/REF
SVY11 [IF SV03=5] In the past 12 months, did you use triazolam in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR TRIAZOLAM
1
Yes
2
No
DK/REF
SVY12 [IF SV04=1] In the past 12 months, did you use Butisol in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR BUTISOL
1
Yes
2
No
DK/REF
SVY13 [IF SV04=2] In the past 12 months, did you use Seconal in any way a doctor did not
direct you to use it?
DISPLAY IMAGE FOR SECONAL
1
Yes
2
No
DK/REF
SVY14 [IF SV04=3] In the past 12 months, did you use phenobarbital in any way a doctor did
not direct you to use it?
DISPLAY IMAGE FOR PHENOBARBITAL
1
Yes
2
No
DK/REF
SVYOTH [IF SVANYOTH =1] In the past 12 months, did you use any [IF SVANYOTH =1
AND SVYRCOUNT > 1 FILL “other”] prescription sedative in a way a doctor did not direct
you to use it?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW CALENDAR WITH 12-MONTH REFERENCE DATE
DEFINE SVMISCOUNT:
INITIALIZE SVMISCOUNT TO 0.
INCREMENT SVMISCOUNT BY 1 FOR EVERY RESPONSE OF YES IN SVY01-SVYOTH.
DEFINE SVFILL2:
IF SVMISCOUNT < 3 AND SVYOTH NE 1 AND SVDKREFFLAG =2 THEN
SVFILL2=”[DRUG NAMES FROM SVY01-SVY14]”.
ELSE IF SVMISCOUNT=1 AND SVYOTH NE 1 AND SVDKREFFLAG=1 THEN SVFILL2
= “[DRUG NAMES FROM SVY01-SVY14] or any other prescription sedative.”
ELSE IF SVMISCOUNT=2 AND SVDKREFFLAG=2 AND SVYOTH=1 THEN
SVFILL2=”[DRUG NAME FROM SVY01-SVY14] and some other prescription sedative.”
ELSE IF SVMISCOUNT=2 AND SVDKREFFLAG=1 THEN SVFILL2=”[DRUG NAMES
FROM SVY01-SVY14]”. IF SVYOTH=1 THEN ADD “some other prescription sedative” TO
THE FILL.
Definitions for Use in the Drugs Module 2
DEFINE PAI12MON:
IF PRY01 = 1 OR PRY02 = 1 OR PRY03 = 1 OR PRY04 = 1 OR PRY05 = 1 OR PRY06 = 1
OR PRY07 =1 OR PRY08 = 1 OR PRY09 = 1 OR PRY10 = 1 OR PRY11 = 1 OR PRY12 = 1
OR PRY13 = 1 OR PRY14 =1 OR PRY15 = 1 OR PRY16 = 1 OR PRY17 = 1 OR PRY18 = 1
OR PRY19 = 1 OR PRY20 = 1 OR PRY21 = 1 OR PRY22 = 1 OR PRY23 = 1 OR PRY24 = 1
OR PRY25 = 1 OR PRY26 = 1 OR PRY27 = 1 OR PRY28 = 1 OR PRY29 = 1 OR PRY30 = 1
OR PRY 31 = 1 OR PRY32 = 1 OR PRY33 = 1 OR PRY34 = 1 OR PRY 35 = 1 OR PRY36 = 1
OR PRY37 = 1 OR PRYOTH = 1, THEN PAI12MON = 1
ELSE PAI12MON = 2
DEFINE TRA12MON:
IF TRY01 = 1 OR TRY02 = 1 OR TRY03 = 1 OR TRY04 = 1 OR TRY05 = 1 OR TRY06 = 1
OR TRY07 = 1 OR TRY08 = 1 OR TRY09 = 1 OR TRY10 = 1 OR TRY11 = 1 OR TRY12 = 1
OR TRY13 = 1 OR TRY14 = 1 OR TRY15 = 1 OR TRYOTH = 1, THEN TRA12MON = 1
ELSE TRA12MON = 2
DEFINE STI12MON:
IF STY01 = 1 OR STY02 = 1 OR STY03 = 1 OR STY04 = 1 OR STY05 = 1 OR STY06 = 1 OR
STY07 = 1 OR STY08 = 1 OR STY09 = 1 OR STY10 = 1 OR STY11 = 1 OR STY12 = 1 OR
STY13 = 1 OR STY14 = 1 OR STY15 = 1 OR STY16 = 1 OR STY17 = 1 OR STY18 = 1 OR
STY19 = 1 OR STY20 = 1 OR STY21 = 1 OR STY22 = 1 OR STY23 = 1 OR STY24 = 1 OR
STY25 = 1 OR STY26 = 1 OR STYOTH = 1, THEN STI12MON= 1
ELSE STI12MON = 2
DEFINE SED12MON
IF SVY01 = 1 OR SVY02 = 1 OR SVY03 = 1 OR SVY04 = 1 OR SVY05 = 1 OR SVY06 = 1
OR SVY07 = 1 OR SVY08 = 1 OR SVY09 = 1 OR SVY10 = 1 OR SVY11 = 1 OR SVY12 = 1
OR SVY13 = 1 OR SVY14 = 1 OR SVYOTH = 1, THEN SED12MON = 1
ELSE SED12MON = 2
CHECKPOINT2: IF (ALC12MON = 4 AND MAR12MON = 4 AND COC12MON = 2 AND
HAL12MON=2 AND INH12MON=2 AND HER12MON = 2 AND MET12MON = 2 AND
PAI12MON = 2 AND TRA12MON = 2 AND STI12MON = 2 AND SED12MON = 2), GO TO
PENTER1.
COGINTRO Please stop and let the interviewer know that you have completed this section.
The interviewer will provide you with additional instructions.
Enter 3-letter code to continue.
Begin Cognitive Testing
COGINTRO Please stop and let the interviewer know that you have completed this section.
The interviewer will provide you with additional instructions.
Enter 3-letter code to continue.
Substance Dependence and Abuse
INTRODR
[IF ALC12MON = 1 OR 2 OR 3 OR MAR12MON = 1 OR 2 OR 3 OR
COC12MON = 1 OR HER12MON = 1 OR HAL12MON = 1 OR INH12MON =
1 OR MET12MON = 1 OR PAI12MON = 1 OR TRA12MON = 1 OR
STI12MON = 1 OR SED12MON = 1] Now we’d like for you to tell us about
your experiences with the
[AND ALC12MON =1 OR 2 OR 3 AND (MAR12MON = 4 AND COC12MON
= 2 AND HER12MON = 2 AND HAL12MON = 2 AND INH12MON = 2 AND
MET12MON = 2 AND PAI12MON = 2 AND TRA12MON = 2 AND
STI12MON = 2 AND SED12MON = 2)] alcohol you drank.
[ALC12MON = 1 OR 2 OR 3 OR AND (MAR12MON = 1 OR 2 OR 3 OR
COC12MON = 1 OR HER12MON = 1 OR HAL12MON = 1 OR INH12MON =
1 OR MET12MON = 1 OR PAI12MON = 1 OR TRA12MON = 1 OR
STI12MON = 1 OR SED12MON = 1)] alcohol you drank and the other drugs that
you used.
[ALC12MON = 4 AND (MAR12MON = 1 OR 2 OR 3 OR COC12MON = 1 OR
HER12MON = 1 OR HAL12MON = 1 OR INH12MON = 1 OR MET12MON =
1 OR PAI12MON = 1 OR TRA12MON = 1 OR STI12MON = 1 OR
SED12MON = 1)] drugs that you used.
Press [ENTER] to continue.
Alcohol
DRALC [IF ALC12MON = 1 - 3] Think about your use of alcohol during the past 12 months
as you answer these next questions.
Press [ENTER] to continue.
(IF ALC12MON = 4, SKIP TO DRMJ)
DRALC01 During the past 12 months, did you spend a great deal of your time drinking alcohol,
feeling its effects, or getting over the effects of drinking?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC02 [IF DRALC01=1 OR DK/REF] During the past 12 months, did you spend a great
deal of your time getting or trying to get alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC03 During the past 12 months, were there many times when you ended up drinking
alcohol in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC04 During the past 12 months, were there times when you wanted to drink alcohol so
badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC05 [IF DRALC04 = 2 OR DK/REF] During the past 12 months, were there times when
you had a strong urge to drink alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC06 During the past 12 months, did you need to drink a lot more alcohol than you used to
in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC07 [IF DRALCO6 = 2 OR DK/REF] During the past 12 months, did drinking the same
amount of alcohol have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC08 During the past 12 months, did you often want to cut down or stop drinking
alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC09 [IF DRALC08 = 2 OR DK/REF] During the past 12 months, did you try to cut down
or stop drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC10a [IF DRALC09 = 1] In the past 12 months, were you able to cut down or stop
drinking alcohol every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC10b [IF DRALC10a = 2 OR DK/REF] Was there more than one time in the past 12
months when you tried but were unable to cut down or stop drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC12 [IF DRALC11 = 1]: Did you continue to drink alcohol even though it was causing
these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC13 [IF DRALC11 = 2 OR DK/REF OR DRALC12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC14 [IF DRALC13 = 1]: Did you continue to drink alcohol even though it was causing
these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC15 [IF DRALC11 = 2 OR DK/REF OR DRALC12 = 2 OR DK/REF or DRALC13=2
OR DK/REF OR DRALC14 = 2 OR DK/REF] During the past 12 months, did you have
blackouts, that is, woke the next day not being able to remember some of the things that
happened while drinking or after drinking alcohol?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC16 [IF DRALC15 = 1]: Did you continue to drink alcohol even though drinking gave
you blackouts?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your alcohol use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC18 Sometimes people who drink alcohol have serious problems at work, school, or
home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your alcohol use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your alcohol use?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC20 [IF DRALC19 = 1]: Did you continue to drink alcohol even though it often caused
arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC21 During the past 12 months, did you repeatedly get into situations where drinking
alcohol increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC22 People may experience withdrawal symptoms when they drink less or stop drinking
alcohol. Withdrawal symptoms are stronger and last longer than a hangover.
During the past 12 months, did you have the following withdrawal symptoms after you drank
less or stopped drinking alcohol for a while?
DRALC22_1 Sweating or feeling that your heart
was beating fast
DRALC22_2 Having your hands tremble
DRALC22_3 Having trouble sleeping
DRALC22_4 Vomiting or having an upset stomach
DRALC22_5 Seeing, hearing, or feeling things that
weren't really there
DRALC22_6 Feeling like you couldn't sit still
DRALC22_7 Feeling anxious
DRALC22_8 Having seizures or fits
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝2
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝1
⃝2
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
DRALC23 During the past 12 months, did you use alcohol or another drug to get over or avoid
having alcohol withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRALC24 [IF DRALC23=1] Did you use any of the following to get over or avoid having
alcohol withdrawal symptoms during the past 12 months?
Yes
No
DRALC24_1 Alcohol
DRALC24_2 Prescription sedatives, tranquilizers, sleeping
⃝ 1
⃝ 2
⃝ 1
⃝ 2
⃝ 1
⃝ 2
pills, or downers
DRALC24_3 Something else
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRALC25 [IF DRALC24_3=1] You indicated that you took something else to get over or avoid
having alcohol withdrawal symptoms during the past 12 months. What did you take?
______________________________________
DK/REF
Marijuana
DRMJ [IF MAR12MON = 1 - 3] Think about your use of marijuana or hashish during the
past 12 months as you answer these next questions.
Press [ENTER] to continue.
(IF MAR12MON = 4, SKIP TO DRCC)
DRMJ01 During the past 12 months, did you spend a great deal of your time using marijuana
or hashish, feeling their effects, or getting over the effects of marijuana?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ02 [IF DRMJ01=1 OR DK/REF] During the past 12 months, did you spend a great deal
of your time getting or trying to get marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ03 During the past 12 months, were there many times when you ended up using
marijuana or hashish in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ04 During the past 12 months, were there times when you wanted to use marijuana or
hashish so badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ05 [IF DRMJ04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ06 During the past 12 months, did you need to use a lot more marijuana or hashish than
you used to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ07 [IF DRMJO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of marijuana or hashish have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ08 During the past 12 months, did you often want to cut down or stop using marijuana
or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ09 [IF DRMJ08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ10a [IF DRMJ09 = 1] In the past 12 months, were you able to cut down or stop using
marijuana or hashish every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ10b [IF DRMJ0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using marijuana or
hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ12 [IF DRMJ11 = 1]: Did you continue to use marijuana or hashish even though it was
causing these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ13 [IF DRMJ11 = 2 OR DK/REF OR DRMJ12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ14 [IF DRMJ13 = 1]: Did you continue to use marijuana or hashish even though it was
causing these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ18 Sometimes people who use marijuana or hashish have serious problems at work,
school, or home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of marijuana or hashish?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ20 [IF DRMJ19 = 1]: Did you continue to use marijuana or hashish even though it often
caused arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ21 During the past 12 months, did you repeatedly get into situations where using
marijuana or hashish increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ22a People may experience withdrawal symptoms when they use less or stop using
marijuana or hashish.
During the past 12 months, did you have the following withdrawal symptoms after you used less
or stopped using marijuana or hashish for a while?
DRMJ22_1 Feeling irritable or angry
DRMJ22_2 Feeling anxious or nervous
DRMJ22_3 Having trouble sleeping
DRMJ22_4 Losing your appetite or losing weight
without trying to
DRMJ22_5 Feeling like you couldn’t sit still
DRMJ22_6 Feeling depressed
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝1
⃝2
⃝1
⃝1
⃝2
⃝2
DRMJ22b During the past 12 months, did you have the following withdrawal symptoms after
you used less or stopped using marijuana or hashish for a while?
DRMJ22_7 Stomach ache
DRMJ22_8 Shaking or tremors
DRMJ22_9 Sweating
DRMJ22_10 Fever
DRMJ22_11 Chills
DRMJ22_12 Headache
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝1
⃝1
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝2
⃝2
⃝2
DRMJ23 During the past 12 months, did you use marijuana, hashish or another cannabis product
to get over or avoid having marijuana or hashish withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRMJ24 [IF DRMJ23=1] Did you use any of the following to get over or avoid having
marijuana or hashish withdrawal symptoms during the past 12 months?
Yes
No
DRMJ24_1 Marijuana or hashish
⃝ 1
⃝ 2
DRMJ24_2 Something else
⃝ 1
⃝ 2
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRMJ25 [IF DRMJ24_2=1] You indicated that you took something else to get over or avoid
having marijuana or hashish withdrawal symptoms during the past 12 months. What did you
take?
______________________________________
DK/REF
Cocaine
DRCC
[IF COC12MON = 1] Think about your use of cocaine, including the form of
cocaine called ‘crack’ during the past 12 months as you answer these next questions.
Press [ENTER] to continue.
(IF COC12MON = 2, SKIP TO DRHE)
DRCC01 During the past 12 months, did you spend a great deal of your time using cocaine,
feeling its effects, or getting over the effects of cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC02 [IF DRCC01=1 OR DK/REF] During the past 12 months, did you spend a great deal
of your time getting or trying to get cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC03 During the past 12 months, were there many times when you ended up using cocaine
in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC04 During the past 12 months, were there times when you wanted to use cocaine so badly
that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC05 [IF DRCC04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC06 During the past 12 months, did you need to use a lot more cocaine than you used to in
order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC07 [IF DRCCO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of cocaine have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC08 During the past 12 months, did you often want to cut down or stop using cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC09 [IF DRCC08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10a [IF DRCC09 = 1] In the past 12 months, were you able to cut down or stop using
cocaine every time you tried?
1
2
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC10b [IF DRCC0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC12 [IF DRCC11 = 1]: Did you continue to use cocaine even though it was causing these
physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC13 [IF DRCC11 = 2 OR DK/REF OR DRCC12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC14 [IF DRCC13 = 1]: Did you continue to use cocaine even though it was causing these
problems with your emotions or mental health?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC18 Sometimes people who use cocaine have serious problems at work, school, or home—
such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of cocaine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC20 [IF DRCC19 = 1]: Did you continue to use cocaine even though it often caused
arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC21 During the past 12 months, did you repeatedly get into situations where using cocaine
increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC22a People may experience withdrawal symptoms when they use less or stop using
cocaine.
During the past 12 months, have you felt kind of blue or down when you used less or stopped
using cocaine for a while?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC22b [IF DRCC22a=1 ] During the past 12 months, did you have the following withdrawal
symptoms after you used less or stopped using cocaine for a while?
DRCC22_1 Feeling tired or exhausted
DRCC22_2 Having bad dreams
DRCC22_3 Having trouble sleeping or sleeping
more than you normally do
DRCC22_4 Feeling hungry more often
DRCC22_5 Feeling either very slowed down or like
you couldn’t sit still
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝1
⃝2
⃝2
⃝1
⃝2
⃝1
⃝2
⃝1
⃝2
DRCC23 During the past 12 months, did you use cocaine or another drug to get over or avoid
having cocaine withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRCC24 [IF DRCC23=1] Did you use any of the following to get over or avoid having cocaine
withdrawal symptoms during the past 12 months?
Yes
No
DRCC24_1 Cocaine
DRCC24_2 Methamphetamine
DRCC24_3 Prescription stimulants or uppers
DRCC24_4 Something else
⃝ 1
⃝ 1
⃝ 2
⃝ 2
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRCC25 [IF DRCC24_4=1] You indicated that you took something else to get over or avoid
having cocaine withdrawal symptoms during the past 12 months. What did you take?
______________________________________
DK/REF
Heroin
DRHE
[IF HER12MON = 1] Think about your use of heroin during the past 12 months as
you answer these next questions.
Press [ENTER] to continue.
(IF HER12MON = 2, SKIP TO DRLS)
DRHE01 During the past 12 months, did you spend a great deal of your time using heroin,
feeling its effects, or getting over the effects of heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE02 [IF DRHE01=1 OR DK/REF] During the past 12 months, did you spend a great deal
of your time getting or trying to get heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE03 During the past 12 months, were there many times when you ended up using heroin
in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE04 During the past 12 months, were there times when you wanted to use heroin so badly
that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE05 [IF DRHE04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE06 During the past 12 months, did you need to use a lot more heroin than you used to in
order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE07 [IF DRHEO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of heroin have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE08 During the past 12 months, did you often want to cut down or stop using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE09 [IF DRHE08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE10a [IF DRHE09 = 1] In the past 12 months, were you able to cut down or stop using
heroin every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE10b [IF DRHE0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE12 [IF DRHE11 = 1]: Did you continue to use heroin even though it was causing these
physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE13 [IF DRHE11 = 2 OR DK/REF OR DRHE12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE14 [IF DRHE13 = 1]: Did you continue to use heroin even though it was causing these
problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE18 Sometimes people who use heroin have serious problems at work, school, or home—
such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of heroin?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE20 [IF DRHE19 = 1]: Did you continue to use heroin even though it often caused
arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE21 During the past 12 months, did you repeatedly get into situations where using heroin
increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE22 People may experience withdrawal symptoms when they use less or stop using heroin.
During the past 12 months, did you have the following withdrawal symptoms after you used less
or stopped using heroin for a while?
DRHE22_1 Feeling kind of blue or down
DRHE22_2 Vomiting or feeling nauseous
DRHE22_3 Having cramps or muscle aches
DRHE22_4 Having teary eyes or a runny nose
DRHE22_5 Feeling sweaty, having enlarged eye
pupils, or having body hair standing up on your skin
DRHE22_6 Having diarrhea
DRHE22_7 Yawning
DRHE22_8 Having a fever
DRHE22_9 Having trouble sleeping
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝2
⃝1
⃝2
⃝1
⃝ 1
⃝ 1
⃝ 1
⃝2
⃝ 2
⃝ 2
⃝ 2
DRHE23 During the past 12 months, did you use heroin or another drug to get over or avoid
having heroin withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRHE24 [IF DRHE23=1] Did you use any of the following to get over or avoid having heroin
withdrawal symptoms during the past 12 months?
DRHE24_1 Heroin
DRHE24_2 Prescription pain relievers
DRHE24_3 Something else
DK/REF
Yes
No
⃝ 1
⃝ 1
⃝ 1
⃝ 2
⃝ 2
⃝ 2
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRHE25 [IF DRHE24_3=1] You indicated that you took something else to get over or avoid
having heroin withdrawal symptoms during the past 12 months. What did you take?
______________________________________
DK/REF
Hallucinogens
DRLS [IF HAL12MON = 1] Think about your use of hallucinogens, such as LSD, ‘acid’, PCP,
‘Ecstasy’ or ‘Molly’, psilocybin or mushrooms, mescaline, or peyote during the past 12 months
as you answer these next questions.
Press [ENTER] to continue.
(IF HAL12MON = 2, SKIP TO DRIN)
DRLS01 During the past 12 months, did you spend a great deal of your time using
hallucinogens, feeling their effects, or getting over the effects of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS02 [IF DRLS01=1 OR DK/REF] During the past 12 months, did you spend a great deal of
your time getting or trying to get hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS03 During the past 12 months, were there many times when you ended up using
hallucinogens in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS04 During the past 12 months, were there times when you wanted to use hallucinogens so
badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS05 [IF DRLS04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use hallucinogens?
1
2
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS06 During the past 12 months, did you need to use a lot more hallucinogens than you used
to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS07 [IF DRLSO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of hallucinogens have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS08 During the past 12 months, did you often want to cut down or stop using
hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS09 [IF DRLS08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS10a [IF DRLS09 = 1] In the past 12 months, were you able to cut down or stop using
hallucinogens every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS10b [IF DRLS0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS12 [IF DRLS11 = 1]: Did you continue to use hallucinogens even though it was causing
these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS13 [IF DRLS11 = 2 OR DK/REF OR DRLS12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS14 [IF DRLS13 = 1]: Did you continue to use hallucinogens even though it was causing
these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS18 Sometimes people who use hallucinogens have serious problems at work, school, or
home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of hallucinogens?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS20 [IF DRLS19 = 1]: Did you continue to use hallucinogens even though it often caused
arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRLS21 During the past 12 months, did you repeatedly get into situations where using
hallucinogens increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Inhalants
DRIN
[IF INH12MON = 1] Think about your use of inhalants, such as amyl nitrite,
‘poppers,’ nitrous oxide, gasoline or lighter fluids, glue, spray paints, or correction
fluids during the past 12 months as you answer these next questions.
Press [ENTER] to continue.
(IF INH12MON = 2, SKIP TO DRME)
DRIN01 During the past 12 months, did you spend a great deal of your time using inhalants,
feeling their effects, or getting over the effects of inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN02 [IF DRIN01=1 OR DK/REF] During the past 12 months, did you spend a great deal of
your time getting or trying to get inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN03 During the past 12 months, were there many times when you ended up using inhalants
in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN04 During the past 12 months, were there times when you wanted to use inhalants so
badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN05 [IF DRIN04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN06 During the past 12 months, did you need to use a lot more inhalants than you used to
in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN07 [IF DRINO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of inhalants have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN08 During the past 12 months, did you often want to cut down or stop using inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN09 [IF DRIN08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN10a [IF DRIN09 = 1] In the past 12 months, were you able to cut down or stop using
inhalants every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN10b [IF DRIN0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN12 [IF DRIN11 = 1]: Did you continue to use inhalants even though it was causing these
physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN13 [IF DRIN11 = 2 OR DK/REF OR DRIN12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN14 [IF DRIN13 = 1]: Did you continue to use inhalants even though it was causing these
problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN18 Sometimes people who use inhalants have serious problems at work, school, or
home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of inhalants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN20 [IF DRIN19 = 1]: Did you continue to use inhalants even though it often caused
arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRIN21 During the past 12 months, did you repeatedly get into situations where using
inhalants increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Methamphetamine
DRME [IF MET12MON = 1] Think about your use of methamphetamine during the past 12
months as you answer these next questions.
Press [ENTER] to continue.
(IF MET12MON = 2, SKIP TO DRPR)
DRME01 During the past 12 months, did you spend a great deal of your time using
methamphetamine, feeling its effects, or getting over the effects of methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME02 [IF DRME01=1 OR DK/REF] During the past 12 months, did you spend a great deal
of your time getting or trying to get methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME03 During the past 12 months, were there many times when you ended up using
methamphetamine in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME04 During the past 12 months, were there times when you wanted to use
methamphetamine so badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME05 [IF DRME04 = 2 OR DK/REF] During the past 12 months, were there times when
you had a strong urge to use methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME06 During the past 12 months, did you need to use a lot more methamphetamine than
you used to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME07 [IF DRMEO6 = 2 OR DK/REF] During the past 12 months, did using the same
amount of methamphetamine have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME08 During the past 12 months, did you often want to cut down or stop using
methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME09 [IF DRME08 = 2 OR DK/REF] During the past 12 months, did you try to cut down
or stop using methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10a [IF DRME09 = 1] In the past 12 months, were you able to cut down or stop using
methamphetamine every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME10b [IF DRNE0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using
methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME12 [IF DRME11 = 1]: Did you continue to use methamphetamine even though it was
causing these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME13 [IF DRME11 = 2 OR DK/REF OR DRME12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME14 [IF DRME13 = 1]: Did you continue to use methamphetamine even though it was
causing these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME18 Sometimes people who use methamphetamine have serious problems at work,
school, or home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of methamphetamine?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME20 [IF DRME19 = 1]: Did you continue to use methamphetamine even though it often
caused arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME21 During the past 12 months, did you repeatedly get into situations where using
methamphetamine increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME22a People may experience withdrawal symptoms when they use less or stop using
methamphetamine.
During the past 12 months, have you felt kind of blue or down after you used less or stopped
using methamphetamine for a while?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME22b [IF DRME22a=1] During the past 12 months, did you have the following withdrawal
symptoms after you used less or stopped using methamphetamine for a while?
DRME22_1 Feeling tired or exhausted
DRME22_2 Having bad dreams
DRME22_3 Having trouble sleeping or sleeping
more than you normally do
DRME22_4 Feeling hungry more often
Yes
No
⃝1
⃝1
⃝2
⃝2
⃝1
⃝2
⃝1
⃝2
DRME22_5 Feeling either very slowed down or
like you couldn’t sit still
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
⃝1
⃝2
DRME23 During the past 12 months, did you use methamphetamine or another drug to get over
or avoid having methamphetamine withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRME24 [IF DRME23=1] Did you use any of the following to get over or avoid having
methamphetamine withdrawal symptoms during the past 12 months?
DRME24_1 Methamphetamine
DRME24_2 Cocaine or crack
DRME24_3 Prescription stimulants or uppers
DRME24_4 Something else
DK/REF
Yes
No
⃝ 1
⃝ 1
⃝ 1
⃝ 1
⃝ 2
⃝ 2
⃝ 2
⃝ 2
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRME25 [IF DRME24_4=1] You indicated that you took something else to get over or avoid
having methamphetamine withdrawal symptoms during the past 12 months. What did you
take?
______________________________________
DK/REF
Rx Drugs
DRPR [IF PAI12MON = 1] Think about your use of prescription pain relievers during the
past 12 months as you answer these next questions. Remember, we are only interested
in prescription pain relievers that you used in any way a doctor did not direct you
to.
Earlier the computer recorded that in the past 12 months you used [IF
PRMISCOUNT=1 FILL PRFILL2][IF PRMISCOUNT>=2 FILL WITH “the pain
relievers listed below” ] in a way a doctor did not direct you to use [PRNUMFILL].
[IF PRMISCOUNT>=2 FILL WITH DRUG NAMES FROM PRY01-PRY36
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF PRYOTH = 1, ADD
"Some other prescription pain reliever".]
The next questions refer to [IF PRYOTH NE 1 AND PRMISCOUNT=1 FILL
PRFILL2 as a prescription pain reliever; IF PRYOTH = 1 AND PRMISCOUNT=1
FILL WITH “this other prescription pain reliever”; IF PRMISCOUNT>=2 FILL
WITH “these as prescription pain relievers”].
Press [ENTER] to continue.
(IF PAI12MON = 2, SKIP TO DRTR)
DRPR01 During the past 12 months, did you spend a great deal of your time using prescription
pain relievers, feeling their effects, or getting over the effects of prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR02 [IF DRPR01=1 OR DK/REF] During the past 12 months, did you spend a great deal of
your time getting or trying to get prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR03 During the past 12 months, were there many times when you ended up using
prescription pain relievers in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR04 During the past 12 months, were there times when you wanted to use prescription
pain relievers so badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR05 [IF DRPR04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR06 During the past 12 months, did you need to use a lot more prescription pain relievers
than you used to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR07 [IF DRPRO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of prescription pain relievers have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR08 During the past 12 months, did you often want to cut down or stop using prescription
pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR09 [IF DRPR08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR10a [IF DRPR09 = 1] In the past 12 months, were you able to cut down or stop using
prescription pain relievers every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR10b [IF DRPR0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using prescription pain relievers?
1
2
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using prescription pain
relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR12 [IF DRPR11 = 1]: Did you continue to use prescription pain relievers even though it
was causing these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR13 [IF DRPR11 = 2 OR DK/REF OR DRPR12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR14 [IF DRPR13 = 1]: Did you continue to use prescription pain relievers even though it
was causing these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of prescription pain relievers?
1
2
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR18 Sometimes people who use prescription pain relievers have serious problems at
work, school, or home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of prescription pain relievers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR20 [IF DRPR19 = 1]: Did you continue to use prescription pain relievers even though it
often caused arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR21 During the past 12 months, did you repeatedly get into situations where using
prescription pain relievers increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR22 People may experience withdrawal symptoms when they use less or stop using
prescription pain relievers.
During the past 12 months, did you have the following withdrawal symptoms after you used less
or stopped using prescription pain relievers for a while?
DRPR22_1 Feeling kind of blue or down
DRPR22_2 Vomiting or feeling nauseous
DRPR22_3 Having cramps or muscle aches
DRPR22_4 Having teary eyes or a runny nose
DRPR22_5 Feeling sweaty, having enlarged eye
pupils, or having body hair standing up on your skin
DRPR22_6 Having diarrhea
DRPR22_7 Yawning
DRPR22_8 Having a fever
DRPR22_9 Having trouble sleeping
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝2
⃝1
⃝2
⃝1
⃝ 1
⃝ 1
⃝ 1
⃝2
⃝ 2
⃝ 2
⃝ 2
DRPR23 During the past 12 months, did you use prescription pain relievers or another drug to
get over or avoid having prescription pain reliever withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRPR24 [IF DRPR23=1] Did you use any of the following to get over or avoid having
prescription pain reliever withdrawal symptoms during the past 12 months?
DRPR24_1 Prescription pain relievers
DRPR24_2 Heroin
DRPR24_3 Something else
DK/REF
Yes
No
⃝ 1
⃝ 1
⃝ 1
⃝ 2
⃝ 2
⃝ 2
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRPR25 [IF DRPR24_3=1] You indicated that you took something else to get over or avoid
having prescription pain reliever withdrawal symptoms during the past 12 months. What did
you take?
______________________________________
DK/REF
DRTR
[IF TRA12MON = 1] Think about your use of prescription tranquilizers during the
past 12 months as you answer these next questions. Remember, we are only interested
in prescription tranquilizers that you used in any way a doctor did not direct you to.
Earlier the computer recorded that in the past 12 months you used [IF
TRMISCOUNT=1 FILL TRFILL2][IF TRMISCOUNT>=2 FILL WITH “the
tranquilizers listed below” ] in a way a doctor did not direct you to use
[TRNUMFILL].
[IF TRMISCOUNT >=2 FILL WITH DRUG NAMES FROM TRY01- TRY12
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF TRYOTH = 1, ADD
"Some other prescription tranquilizer".]
The next questions refer to [IF TRYOTH NE 1 AND TRMISCOUNT =1 FILL
TRFILL2 as a prescription tranquilizer; IF TRYOTH = 1 AND TRMISCOUNT =1
FILL WITH “this other prescription tranquilizer”; IF TRMISCOUNT >=2 FILL
WITH “these as prescription tranquilizers”].
Press [ENTER] to continue.
(IF TRA12MON = 2, SKIP TO DRST)
DRTR01 During the past 12 months, did you spend a great deal of your time using prescription
tranquilizers, feeling their effects, or getting over the effects of prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR02 [IF DRTR01=1 OR DK/REF] During the past 12 months, did you spend a great deal of
your time getting or trying to get prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR03 During the past 12 months, were there many times when you ended up using
prescription tranquilizers in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR04 During the past 12 months, were there times when you wanted to use prescription
tranquilizers so badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR05 [IF DRTR04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR06 During the past 12 months, did you need to use a lot more prescription tranquilizers
than you used to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR07 [IF DRTRO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of prescription tranquilizers have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR08 During the past 12 months, did you often want to cut down or stop using prescription
tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR09 [IF DRTR08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR10a [IF DRTR09 = 1] In the past 12 months, were you able to cut down or stop using
prescription tranquilizers every time you tried?
1
2
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR10b [IF DRTR0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using prescription
tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR12 [IF DRTR11 = 1]: Did you continue to use prescription tranquilizers even though it
was causing these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR13 [IF DRTR11 = 2 OR DK/REF OR DRTR12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR14 [IF DRTR13 = 1]: Did you continue to use prescription tranquilizers even though it
was causing these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR18 Sometimes people who use prescription tranquilizers have serious problems at work,
school, or home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of prescription tranquilizers?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR20 [IF DRTR19 = 1]: Did you continue to use prescription tranquilizers even though it
often caused arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR21 During the past 12 months, did you repeatedly get into situations where using
prescription tranquilizers increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRTR22 People may experience withdrawal symptoms when they use less or stop using
prescription tranquilizers.
During the past 12 months, did you have the following withdrawal symptoms after you used less
or stopped using prescription tranquilizers for a while?
DRTR22_1 Sweating or feeling that your heart was
beating fast
DRTR22_2 Having your hands tremble
DRTR22_3 Having trouble sleeping
DRTR22_4 Vomiting or having an upset stomach
DRTR22_5 Seeing, hearing, or feeling things that
weren't really there
DRTR22_6 Feeling like you couldn't sit still
DRTR22_7 Feeling anxious
DRTR22_8 Having seizures or fits
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝2
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝1
⃝2
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
DRTR23 During the past 12 months, did you use prescription tranquilizers or another drug to get
over or avoid having prescription tranquilizer withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRTR24 [IF DRTR23=1] Did you use any of the following to get over or avoid having
prescription tranquilizer withdrawal symptoms during the past 12 months?
DRTR24_1 Prescription tranquilizers, sedatives, downers, or
sleeping pills
DRTR24_2 Alcohol
DRTR24_3 Something else
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝ 1
⃝ 2
⃝ 1
⃝ 1
⃝ 2
⃝ 2
DRTR25 [IF DRTR24_3=1] You indicated that you took something else to get over or avoid
having prescription tranquilizer withdrawal symptoms during the past 12 months. What did
you take?
______________________________________
DK/REF
DRST
[IF ST12MON = 1] Think about your use of prescription stimulants during the past
12 months as you answer these next questions. Remember, we are only interested in
prescription stimulants that you used in any way a doctor did not direct you to.
Earlier the computer recorded that in the past 12 months you used [IF
STMISCOUNT =1 FILL STFILL2][IF STMISCOUNT >=2 FILL WITH “the
stimulants listed below” ] in a way a doctor did not direct you to use
[STNUMFILL].
[IF STMISCOUNT >=2 FILL WITH DRUG NAMES FROM STY01-STY26
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF STYOTH = 1, ADD
"Some other prescription stimulant".]
The next questions refer to [IF STYOTH NE 1 AND STMISCOUNT =1 FILL
STFILL2 as a prescription stimulant; IF STYOTH = 1 AND STMISCOUNT =1 FILL
WITH “this other prescription stimulant”; IF STMISCOUNT >=2 FILL
WITH “these as prescription stimulants”].
Press [ENTER] to continue.
(IF ST12MON = 2, SKIP TO DRSV)
DRST01 During the past 12 months, did you spend a great deal of your time using prescription
stimulants, feeling their effects, or getting over the effects of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST02 [IF DRST01=1 OR DK/REF] During the past 12 months, did you spend a great deal of
your time getting or trying to get prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST03 During the past 12 months, were there many times when you ended up using
prescription stimulants in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST04 During the past 12 months, were there times when you wanted to use prescription
stimulants so badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST05 [IF DRST04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST06 During the past 12 months, did you need to use a lot more prescription stimulants
than you used to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST07 [IF DRSTO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of prescription stimulants have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST08 During the past 12 months, did you often want to cut down or stop using prescription
stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST09 [IF DRST08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10a [IF DRST09 = 1] In the past 12 months, were you able to cut down or stop using
prescription stimulants every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST10b [IF DRST0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using prescription
stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST12 [IF DRST11 = 1]: Did you continue to use prescription stimulants even though it was
causing these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST13 [IF DRST11 = 2 OR DK/REF OR DRST12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST14 [IF DRST13 = 1]: Did you continue to use prescription stimulants even though it was
causing these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST18 Sometimes people who use prescription stimulants have serious problems at work,
school, or home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of prescription stimulants?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST20 [IF DRST19 = 1]: Did you continue to use prescription stimulants even though it
often caused arguments or problems with family or friends?
1
2
Yes
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST21 During the past 12 months, did you repeatedly get into situations where using
prescription stimulants increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST22a People may experience withdrawal symptoms when they use less or stop using
prescription stimulants.
During the past 12 months, have you felt kind of blue or down after you used less or stopped
using prescription stimulants for a while?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST22b [IF DRST22a=1 ] During the past 12 months, did you have the following withdrawal
symptoms after you used less or stopped using prescription stimulants for a while?
DRST22_1 Feeling tired or exhausted
DRST22_2 Having bad dreams
DRST22_3 Having trouble sleeping or sleeping
more than you normally do
DRST22_4 Feeling hungry more often
DRST22_5 Feeling either very slowed down or like
you couldn’t sit still
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
Yes
No
⃝1
⃝1
⃝2
⃝2
⃝1
⃝2
⃝1
⃝2
⃝1
⃝2
DRST23 During the past 12 months, did you use prescription stimulants or another drug to get
over or avoid having prescription stimulant withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRST24 [IF DRST23=1] Did you use any of the following to get over or avoid having
prescription stimulant withdrawal symptoms during the past 12 months?
DRST24_1 Prescription stimulants or uppers
DRST24_2 Cocaine or crack
DRST24_3 Methamphetamine
DRST24_4 Something else
DK/REF
Yes
No
⃝ 1
⃝ 1
⃝ 1
⃝ 1
⃝ 2
⃝ 2
⃝ 2
⃝ 2
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRST25 [IF DRST24_4=1] You indicated that you took something else to get over or avoid
having prescription stimulant withdrawal symptoms during the past 12 months. What did you
take?
______________________________________
DK/REF
DRSV
[IF SV12MON = 1] Think about your use of prescription sedatives during the past
12 months as you answer these next questions. Remember, we are only interested in
prescription sedatives that you used in any way a doctor did not direct you to.
Earlier the computer recorded that in the past 12 months you used [IF
SVMISCOUNT =1 FILL SVFILL2][IF SVMISCOUNT >=2 FILL WITH “the
sedatives listed below” ] in a way a doctor did not direct you to use
[SVNUMFILL].
[IF SVMISCOUNT >= 2 FILL WITH DRUG NAMES FROM SVY01-SVY14
BELOW. USE MULTIPLE COLUMNS AS NEEDED. IF SVYOTH = 1, ADD
"Some other prescription sedative".]
The next questions refer to [IF SVYOTH NE 1 AND SVMISCOUNT =1 FILL
SVFILL2 as a prescription sedative; IF SVYOTH = 1 AND SVMISCOUNT =1 FILL
WITH “this other prescription sedative”; IF SVMISCOUNT >=2 FILL WITH “these
as prescription sedatives”].
Press [ENTER] to continue.
(IF SV12MON = 2, SKIP TO PENTER1)
DRSV01 During the past 12 months, did you spend a great deal of your time using prescription
sedatives, feeling their effects, or getting over the effects of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV02 [IF DRSV01=1 OR DK/REF] During the past 12 months, did you spend a great deal of
your time getting or trying to get prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV03 During the past 12 months, were there many times when you ended up using
prescription sedatives in larger amounts or for a longer time than you meant to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV04 During the past 12 months, were there times when you wanted to use prescription
sedatives so badly that you couldn't think of anything else?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV05 [IF DRSV04 = 2 OR DK/REF] During the past 12 months, were there times when you
had a strong urge to use prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV06 During the past 12 months, did you need to use a lot more prescription sedatives than
you used to in order to get the feeling you wanted?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV07 [IF DRSVO6 = 2 OR DK/REF] During the past 12 months, did using the same amount
of prescription sedatives have much less effect on you than it used to?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV08 During the past 12 months, did you often want to cut down or stop using prescription
sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV09 [IF DRSV08 = 2 OR DK/REF] During the past 12 months, did you try to cut down or
stop using prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV10a [IF DRSV09 = 1] In the past 12 months, were you able to cut down or stop using
prescription sedatives every time you tried?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV10b [IF DRSV0a = 2 OR DK/REF] Was there more than one time in the past 12 months
when you tried but were unable to cut down or stop using prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV11 During the past 12 months, did you have any long-lasting [IF VERSION=2: or
repeated] physical health problems that were caused or made worse by using prescription
sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV12 [IF DRSV11 = 1]: Did you continue to use prescription sedatives even though it was
causing these physical health problems or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV13 [IF DRSV11 = 2 OR DK/REF OR DRSV12 = 2 OR DK/REF] During the past 12
months, did you have any long-lasting [IF VERSION=2: or repeated] problems with emotions or
mental health that were caused or made worse by using prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV14 [IF DRSV13 = 1]: Did you continue to use prescription sedatives even though it was
causing these problems with your emotions or mental health or making them worse?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV17 This question is about important activities such as:
Attending special events at work or school
Participating in hobbies and sports
Attending religious services and events
Spending time with friends and family
During the past 12 months, did you give up or spend a lot less time doing any of these types of
important activities because of your use of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV18 Sometimes people who use prescription sedatives have serious problems at work,
school, or home—such as:
missing a lot of work or school
getting demoted, having your hours cut, or losing a job
getting suspended, expelled, or dropping out of school
failing to take care of family
During the past 12 months, did you have serious problems like this either at work, school, or
home because of your use of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV19 During the past 12 months, did you often have arguments or other problems with
family or friends that were caused or made worse by your use of prescription sedatives?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV20 [IF DRSV19 = 1]: Did you continue to use prescription sedatives even though it often
caused arguments or problems with family or friends?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV21 During the past 12 months, did you repeatedly get into situations where using
prescription sedatives increased your chances of getting physically hurt?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV22 People may experience withdrawal symptoms when they use less or stop using
prescription sedatives.
During the past 12 months, did you have the following withdrawal symptoms after you used less
or stopped using prescription sedatives for a while?
DRSV22_1 Sweating or feeling that your heart was
beating fast
DRSV22_2 Having your hands tremble
DRSV22_3 Having trouble sleeping
DRSV22_4 Vomiting or having an upset stomach
DRSV22_5 Seeing, hearing, or feeling things that
weren't really there
Yes
No
⃝1
⃝2
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
⃝1
⃝2
DRSV22_6 Feeling like you couldn't sit still
DRSV22_7 Feeling anxious
DRSV22_8 Having seizures or fits
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
⃝1
⃝1
⃝1
⃝2
⃝2
⃝2
DRSV23 During the past 12 months, did you use prescription sedatives or another drug to get
over or avoid having prescription sedative withdrawal symptoms?
1
Yes
2
No
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
PROGRAMMER: DISPLAY IN LOWER RIGHT:
Press [F2] to see these symptoms again.
DRSV24 [IF DRSV23=1] Did you use any of the following to get over or avoid having
prescription sedative withdrawal symptoms during the past 12 months?
DRSV24_1 Prescription sedatives, tranquilizers, sleeping pills,
or downers
DRSV24_2 Alcohol
DRSV24_3 Something else
Yes
No
⃝ 1
⃝ 2
⃝ 1
⃝ 1
⃝ 2
⃝ 2
DK/REF
PROGRAMMER: SHOW 12 MONTH CALENDAR
DRSV25 [IF DRSV24_3=1] You indicated that you took something else to get over or avoid
having prescription sedative withdrawal symptoms during the past 12 months. What did you
take?
______________________________________
DK/REF
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| File Type | application/pdf |
| File Title | Microsoft Word - NSDUH SUD_Electronic Attachment Dividers_PDF 5.doc |
| Author | allewis |
| File Modified | 2018-03-13 |
| File Created | 2018-03-13 |