Drug Survey Questionnaire

The primary objective of a drug survey questionnaire is to find out how drug affects the younger population of people in the US or in any country and how it can be controlled. A drug survey questionnaire contains several multiple choice questions that are targeted at people who are more prone to drugs and alcohol abuse. The information gathered helps social organizations to devise drug awareness campaigns and serve the society and people in a better way.

Sample Drug Survey Questionnaire:

Name of the Participant: _____________________________

Gender: _________________ (M/F) |  Age: ___________

Occupation:__________________ Marital Status: _________________________

Address: ______________________________________  City:_______________

State: __________________  Zip: ________________

Email: _____________________________

Phone Number: ____________________________

  • Which of the following statements are true? (Please mention T/F against each statement)

a)      Your college campus has strong anti-drug policies

b)      Drugs are banned within the college campus

c)      Drugs are banned in the office area

d)     Drug awareness program exists in your college/workplace

e)      Active representation by students/employees in anti-drug campaigns

  • At what age did you start using the following? (Specify if you have or are using any of the following)

a)      Cigarettes

b)      Other Tobacco products

c)      Marijuana

d)     Amphetamines

e)      Cocaine

f)       Inhalants

g)      Sedatives

h)      Opiates

i)        Steroids

j)        Hallucinogens

k)      Designer drugs

l)        Others: ________________________ (Please Specify)

  • Which of the following reasons do you owe for increasing drug abuse?

a)      Broken families / Increasing Divorces

b)      Bad company / friends

c)      Increase in Rave parties

d)     Easy availability of drugs

e)      Pressure from seniors/peers

  • Which of the following specific drugs have you used in the last 3 years?

a)      Hash / hash oil

b)      LSD

c)      Heroin

d)     Freebase

e)      PCP

f)       Ecstasy

g)      Downers

h)      Solvents

i)        MDMA

j)        None of the above

k)      I don’t do drugs

l)        Others: _______________________ (Please Specify)

Category: Survey Questionnaire

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