Personal Details
| 1. DATE OF BIRTH: Write in your day and month of birth. | (5-8) |
| 2. YOUR GENDER: 1. Male 2. Female | (9) |
3. ETHNIC BACKGROUND1. Scottish 4. Welsh | (10) |
| 4. AGE: (write in) | (11-12) |
5. FACULTY OR COURSE OF STUDY:1. Medicine 9. Commerce | (13-14) |
| 6. Year in Further/Higher Education 1. First 4. Fourth 2. Second 5. Fifth 3. Third 6. Sixth or above | (15) |
| 7. IN WHICH RELIGION WERE YOU BROUGHT UP? 1. Church of Scotland 2. Church of England 3. Other Protestant (religion allows drinking alcholic beverages) 4. Other Protestant (religion does not allow drinking alcoholic beverages) 5. Roman Catholic 6. Others or none (write in) | (16) |
| 8. HOW IMPORTANT IS RELIGION TO YOU? 1. Very important 2. Moderately important 3. Mildly important 4. Not important | (17) |
| 9. WHERE DO YOU LIVE? 1. With my parents 2. In a university/college Hall of residence flat 3. In a flat 4. Other (write in) | (18) |
| INFORMATION CONCERNING THE FREQUENCY OF USE OF VARIOUS SUBSTANCES How often do you use the following substances without a doctor's presription? Use the following code when answering questions 10 through 26. 1. every day 2. at least once a week but not every day 3. at least once a month but less than once a week 4. more than once a year but less than once a month 5. once a year or less 6. not during a year or less 7. Never | |
| 10. BEER/LAGER/CIDER/STOUT | (19) |
| 11. WINE | (20) |
| 12. SPIRITS | (21) |
| 13. TOBACCO | (22) |
| 14. PAINKILLERS: Aspirin, etc. | (23) |
| 15. COFFEE | (24) |
| 16. TEA | (25) |
| 17. COCAINE (Coke, Crack) | (26) |
| 18. STIMULANTS Amphetemines, (speed, pep pills) | (27) |
| 19. SEDATIVES: Barbituates, (Sleeping pills, barbs, downers) | (28) |
| 20. CANNABIS (Pot, Marijuana) | (29) |
| 21. TRANQUILIZERS: Valium, Ativan, Librium, etc. | (30) |
| 22. HEROIN (Smack) | (31) |
| 23. ANTIHISTAMINES: Benadryl, etc. | (32) |
| 24. HALLUCINOGENS LSD, Mushrooms, etc. | (33) |
| 25. ECSTASY: (MDA) | (34) |
| 26. OPIATE: Pain Killers (Morphine, Demerol) | (35) |
| INFORMATION CONCERNING THE AMOUNT OF VARIOUS SUBSTANCES USED | |
| 27. On those days when you drink beer, lager, cider, or stout, how many pints do you usually have? (write-in) | (36-37) |
| 28. On those days when you drink wine, how many glasses do you usually have? (write-in) | (38-39) |
| 29. On those days when you drink spirits, how many standard pub measures would you usually have? (write-in) | (40-41) |
| 30. On those days when you drink coffee, how many cups would you usually have? (write-in) | (42-43) |
| 31. On those days when you drink tea, how many cups would you usually have? (write-in) | (44-45) |
| 32. On those days when you would use painkillers how many tablets or equivalent in powder would you use? (write-in) | (46-47) |
| 33. On those days when you smoke cannabis or use hashish how many joints or the equivalent would you normally use? (write-in) | (48-49) |
| 34. On those days when you would smoke cigarettes, how many would you normally smoke? (write-in) | (50-51) |
| 35. Write in the number of drinks you consumed during this past week. Pints of Beer/Ale/Lager/Cider/Stout Glasses of Wine Nips of Spirits | (52-53)
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| The following are common results of drinking that other students have reported. If you have never consumed an alcoholic beverage you may skip the rest of the questions. Put the number corresponding to the frequency and the occurrence in the box. 1. At least once during the past year. | |
| 36. had a hangover | (58) |
| 37. gotten nauseated and vomited from drinking | (59) |
| 38. driven a car after having several drinks | (60) |
| 39. driven a car when you knew you had too much to drink | (61) |
| 40. driven a car while drinking | (62) |
| 41. come to class after having several drinks | (63) |
| 42. "cut a class" after having several drinks | (64) |
| 43. missed a class because of hangover | (65) |
| 44. arrested for DWI (Driving While Intoxicated) | (66) |
| 45. been criticized by someone you were dating | (67) |
| 46. trouble with the law because of drinking | (68) |
| 47. lost a job because of drinking | (69) |
| 48. got a lower grade because of drinking too much | (70) |
| 49. gotten in trouble with college/university administration because of behavior resulting from drinking too much | (71) |
| 50. gotten into a fight after drinking | (72) |
| 51. thought you might have a problem with your drinking | (73) |
| 52. damaged property, pulled a false alarm, or other such behavior after drinking | (74) |
| 53. participated in a drinking game | (75) |
| 54. forced someone or were forced to have sex | (76) |