Original | 1. Have you ever used psychotropic drugs? _____ Yes _____ No |
G1 | Question
2: Have you ever taken any pharmaceutical capable of affecting the mind,
emotions, and behavior? For instance, Xanax (alprazolam), Zoloft
(sertraline), Celexa (citalopram), Prozac (fluoxetine), and Ativan
(lorazepam), etc. A. Yes B. No |
G2 | 9.
Have you ever used psychotropic drugs? _____ Yes _____ No _____Prefer Not to Answer |
G3 | The
following questions refer to your use of psychotropic drugs. Psychotropic
drugs refer to any drug that can affect your mind, emotions or behaviors and
can be legal or illegal. Legal versions include medication for bipolar
disorder. Illegal versions include cocaine, LSD etc. 3a. Have you ever used psychotropic drugs? _____ Yes _____ No 3b. If yes, how often do you use psychotropic drugs? _____ sometimes _____ usually _____ frequently _____ never 3c. Please list the type of psychotropic drugs you have taken. |
G4 | The
following questions ask about recreational drug use. For this questionnaire,
recreational drug use refers to the use of any drug for purposes other than
its prescribed purpose and/or in excess of its prescribed dosage, including
but not limited to Percocet, OxyContin, and valium; as well as the use of
illegal substances, including but not limited to cocaine, heroin, and
methamphetamine. 12. Have you ever used drugs recreationally? _____ Yes _____ No 13. How frequently do you use drugs recreationally in an average month? ____1-2 ____3-4 ____5 or more ____None at all |
G5 | 1.
Have you ever used any of the following drugs? Check all that apply. _____ Marijuana _____ Cocaine _____ Amphetamines _____ Heroin _____ Mushrooms _____ LSD _____ Ecstasy _____ None of the above |