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The Relationship Between Mental Health and Substance Abuse Among Adolescents 

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Appendix C

NHSDA Questionnaire Items Used


APPENDIX C: NHSDA Questionnaire Items Used

DEMOGRAPHIC CHARACTERISTICS

Recorded Sex

What is your date of birth?

SUBSTANCE USE

1. Cigarettes

How long has it been since you last smoked a cigarette?

Think specifically about the past 30 days -- that is, from your 30-day reference data up to and including today. During the past 30 days, on how many days did you smoke a cigarette? 2. Alcohol

How long has it been since you last drank an alcoholic beverage?

During the past 30 days, on how many days did you have 5 or more drinks on the same occasion? By "occasion," we mean at the same time or within a couple of hours of each other.

During the past 12 months, when you drank alcoholic beverages, on how many days did you get very high or drunk?

3. Marijuana

How long has it been since you last used marijuana or hashish?

4. Cocaine

Have you ever, even once, used any form of cocaine?

How long has it been since you last used any form of cocaine?

5. Crack

Have you ever, even once, used "crack?"

How long has it been since you first used "crack?"

6. Heroin

Have you ever, even once, used heroin?

7. Hallucinogens

Please mark one box beside each hallucinogen to indicate whether you have ever used hallucinogen, even once?

How long has it been since you last used LSD, PCP, or any other hallucinogen? 8. Inhalants

Please mark one box beside each inhalant to indicate whether you have ever used any of the following kind of inhalant, even once, for kicks or to get high?

How long has it been since you last used any inhalant for kicks or to get high? 9. Psychotherapeutics

As you read the following list of prescription pain killers, please mark one box beside each pain killer to indicate whether you have ever used that pain killer when it was not prescribed for you, or that you took only for the experience or feeling it caused. Again, we are interested in all kinds of prescription pain killers, in pill or non-pill form.

As you read the following list of prescription tranquilizers, please mark one box beside each tranquilizer to indicate whether you have ever used that tranquilizer when it was not prescribed for you, or that you took only for the experience or feeling it caused. Again, we are interested in all kinds of prescription tranquilizers, in pill or non-pill form. As you read the following list of prescription stimulants, please mark one box beside each stimulant to indicate whether you have ever used that when it was not prescribed for you, or that you took only for the experience or feeling caused. Again, we are interested in all kinds of prescription stimulants, in non-pill form. As you read the following list of prescription sedatives, please mark one box beside each sedative to indicate whether you have ever used that sedative when it was not prescribed for you, or that you took only for the experience or feeling it caused. Again, we are interested in all kinds of prescription sedatives, in pill or non-pill form. INJECTION DRUG USE

Have you ever, even once, used a needle to inject a drug that was not prescribed for you, or that you took only for the experience or feeling it caused?

PROBLEMS CAUSED BY DRUG USE (Beginning in 1995)

As you read the following list of types of drugs, please mark one box beside each type of drug to indicate whether...

PROBLEMS CAUSED BY DRUG USE (1994)

As you read the following list of types of drugs, please mark one box beside each type of drug to indicate whether

As you read the following list of types of drugs, please mark one box beside each type of drug: TREATMENT

Have you ever received treatment or counseling for your use of alcohol or any drug, not counting cigarettes?

How many times in the past 12 months have you received treatment or counseling for use of alcohol or any drug, not counting cigarettes?

As you read the following list of places where treatment for drug use is offered, please mark one box beside each type of treatment place to indicate whether you have received treatment for your use of other drugs not counting cigarettes or alcohol in that type of facility during the past 12 months.

How long has it been since you last received treatment or counseling for your alcohol or drug use, not counting cigarettes? Where did you receive treatment the last time you were treated for your alcohol or other drug use, not counting cigarettes? As you read the following list of drugs, please mark one box beside each type of drug to indicate whether you received treatment or counseling for your use of that kind of drug the last time you received treatment. What was the primary drug you received treatment for during the last time you were treatment?

PSYCHOLOGICAL FUNCTIONING

Below is a list of items that describe young people. Think about whether each item describes you now or within the past 6 months. Please mark the box next to the "1" if the item is not true of you. Mark the box next to the "2" if the item is somewhat or sometimes true of you. If the item is very true or often true of you, mark the box next to the"3'. Please mark only one box for each question.

Note: This answer sheet contains a list of questions about problems and experiences pertaining to youths. This scale was developed by Dr. Thomas Achenbach, and was used on the NHSDA with his permission. Due to copyright restrictions, the questions are not shown in this report.

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This page was last updated on August 05, 2008.

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.

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