Core Alcohol and Drug Survey

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Form 194 Core Alcohol and Drug Survey For additional use: Long Form A 0 1 2 3 4 5 6 7 8 9 B 0 1 2 3 4 5 6 7 8 9 FIPSE Core Analysis Grantee Group Core Institute C 0 1 2 3 4 5 6 7 8 9 Student Health Programs 0 1 2 3 4 5 6 7 8 9 Southern Illinois University D Please use a number 2 Pencil. Carbondale, IL 62901 E 0 1 2 3 4 5 6 7 8 9

1. Classification: 2. Age: 3. Ethnic origin: 4. Marital status: Freshman ...... American Indian/ Single ...... Sophomore ...... Alaskan Native ...... Married ...... Junior ...... 0 0 Hispanic ...... Separated ...... Senior...... 1 1 Asian/Pacific Islander . . . . Divorced...... Grad/professional ...... 2 2 White (non-Hispanic) . . . . Widowed ...... Not seeking a 3 3 Black (non-Hispanic) . . . . degree ...... 4 4 Other ...... 7. Are you working? Other ...... 5 5 Ye s, full-time ...... 6 6 6. Is your current residence Ye s, part-time ...... 5. Gender: 7 7 as a student: No ...... Male ...... 8 8 On-campus ...... Female ...... 9 9 Off-campus ...... 8. Living arrangements: A. Where: (mark best answer) 9. Approximate cumulative grade point average: (choose one) House/apartment/etc. . . . . Residence hall ...... A+AA- B+BB- C+CC- D+DD-F Approved housing...... Fraternity or sorority ...... 10. Some students have indicated that alcohol or drug use at parties they attend in and Other ...... around campus reduces their enjoyment, often leads to negative situations, and therefore, they would rather not have alcohol and drugs available and used. Other B. With whom: students have indicated that alcohol and drug use at parties increases their (mark all that apply) enjoyment, often leads to positive situations, and therefore, they would rather have With roommate(s)...... alcohol and drugs available and used. Which of these is closest to your own view? Alone ...... Have available Not have available With parent(s) ...... With regard to drugs? ...... With spouse ...... With regard to alcohol?...... With children ...... Other ...... 11.Student status: 12. Campus situation on alcohol and drugs: yesnodon’t know Full-time (12+ credits) . . . . a. Does your campus have alcohol and drug policies? ...... Part-time (1Ð11 credits) . . b. If so, are they enforced? ...... c. Does your campus have a drug and alcohol 13.Place of permanent prevention program? ...... residence: d. Do you believe your campus is concerned about In-state ...... the prevention of drug and alcohol use? ...... USA, but out of state . . . . e. Are you actively involved in efforts to prevent drug Country other than USA . . and alcohol use problems on your campus? ......

Did not use 14. Think back over the last 15.Average # of 16. At what age did you Under 10

10Ð11 two weeks. How many drinks* you first use… 12Ð13 14Ð15 16Ð17 18Ð20 21Ð25 26+ times have you had consume a week: (mark one for each line) five or more drinks* a.Tobacco (smoke, chew, snuff) . . . . at a sitting? b. Alcohol (beer, wine, liquor)* ...... None ...... 0 0 c. Marijuana (pot, hash, hash oil) . . . . (If less than Once ...... 1 1 d. Cocaine (crack, rock, freebase) . . 10, code Twice ...... 2 2 e. Amphetamines (diet pills, speed) . . answers as 3 to 5 times ...... 3 3 f. Sedatives (downers, ludes) ...... 00, 01, 02, 6 to 9 times ...... 4 4 g. Hallucinogens (LSD, PCP)...... etc.) 10 or more times ...... 5 5 h. Opiates (heroin, smack, horse). . . . 6 6 i. Inhalants (glue, solvents, gas) . . . . *A drink is a bottle of beer, a glass 7 7 j. Designer drugs (ecstasy, MDMA) . . of wine, a wine cooler, a shot glass 8 8 k. Steroids ...... of liquor, or a mixed drink. 9 9 l. Other illegal drugs ...... *Other than a few sips

17.Within the last year 3 times/w 5 times/w 18.During the past 30 days 6 times/y Once/monthT Did not use wice/monthOnce/w 10Ð19 da 20Ð29 da Once/y All 30 da Ev about how often have on how many days 1Ð2 da 3Ð5 da 6Ð9 da er 0 da you used… y da did you have: ear ear eek eek eek ys ys ys ys ys ys ys (mark one for each line) y (mark one for each line) a.Tobacco (smoke, chew, snuff) . . a.Tobacco (smoke, chew, snuff) . . . . b. Alcohol (beer, wine, liquor) . . . . b. Alcohol (beer, wine, liquor) ...... c. Marijuana (pot, hash, hash oil). . c. Marijuana (pot, hash, hash oil) . . . . d. Cocaine (crack, rock, freebase) d. Cocaine (crack, rock, freebase) . . e. Amphetamines (diet pills, speed) e. Amphetamines (diet pills, speed) . . f. Sedatives (downers, ludes) . . . . f. Sedatives (downers, ludes) ...... g. Hallucinogens (LSD, PCP) . . . . g. Hallucinogens (LSD, PCP)...... h. Opiates (heroin, smack, horse) h. Opiates (heroin, smack, horse). . . . i. Inhalants (glue, solvents, gas) . . i. Inhalants (glue, solvents, gas) . . . . j. Designer drugs (ecstasy, MDMA) j. Designer drugs (ecstasy, MDMA) . . k. Steroids ...... k. Steroids ...... l. Other illegal drugs ...... l. Other illegal drugs ......

19.How often do you 3 times/w 5 times/w 21.Please indicate how often 6 times/y Once/monthT wice/monthOnce/w Once/y think the average student Ev you have experienced 10 or more times er Ne on your campus uses… y da the following due to ver ear ear eek eek eek 3Ð5 times (mark one for each line) y your drinking or drug use 6Ð9 times

Ne Once T a.Tobacco (smoke, chew, snuff) . . during the last year… wice v b. Alcohol (beer, wine, liquor) . . . . (mark one for each line) er c. Marijuana (pot, hash, hash oil). . a. Had a hangover ...... d. Cocaine (crack, rock, freebase) b.P erformed poorly on a test e. Amphetamines (diet pills, speed) or important project ...... f. Sedatives (downers, ludes) . . . . c. Been in trouble with police, g. Hallucinogens (LSD, PCP) . . . . residence hall, or other h. Opiates (heroin, smack, horse) college authorities ...... i. Inhalants (glue, solvents, gas) . . d. Damaged property, pulled j. Designer drugs (ecstasy, MDMA) fire alarm, etc...... k. Steroids ...... e. Got into an argument or fight ...... l. Other illegal drugs ...... f. Got nauseated or vomited ...... g. Driven a car while under the influence ...... On campus e h. Missed a class ...... Where y 20. Where have you Residence hall Bar/restaur Pr F ivate par i. Been criticized by someone Ne r at/soror used… ver used In a car I know ...... ou live (mark all that apply) vents Other j. Thought I might have a drinking ant ties ity or other drug problem ...... a.Tobacco (smoke, chew, snuff) . . k. Had a memory loss ...... b. Alcohol (beer, wine, liquor) . . . . l. Done something I later regretted . . . . c. Marijuana (pot, hash, hash oil). . m. Been arrested for DWI/DUI...... d. Cocaine (crack, rock, freebase) n. Have been taken advantage e. Amphetamines (diet pills, speed) of sexually ...... f. Sedatives (downers, ludes) . . . . o. Have taken advantage of g. Hallucinogens (LSD, PCP) . . . . another sexually ...... h. Opiates (heroin, smack, horse) p. Tr ied unsuccessfully to stop using. . . . i. Inhalants (glue, solvents, gas) . . q. Seriously thought about suicide...... j. Designer drugs (ecstasy, MDMA) r. Seriously tried to commit suicide . . . . k. Steroids ...... s. Been hurt or injured...... l. Other illegal drugs ...... 23. If you volunteer any of your time on or off campus 22. Have any of your family had alcohol or other to help others, please indicate the approximate drug problems: (mark all that apply) number of hours per month and principal activity: Mother Brothers/sisters Spouse Don’t volunteer, or 10Ð15 hours Father Mother’s parents Children less than 1 hour 16 or more hours Stepmother Father’s parents None 1Ð4 hours Principal volunteer activity is: Stepfather Aunts/uncles 5Ð9 hours

24.Within the last year to 27. Do you believe that alcohol has what extent have you Activ the following effects?

e in participated in any of the Not in (mark one for each line) non-leaderv Leadership following activities? Attended olv yesno position v ement, (mark one for each line) olv a. Breaks the ice ...... ed b. Enhances social activity ...... a. Intercollegiate athletics ...... n/a c. Makes it easier to deal with stress ...... b. Intramural or club sports...... n/a d.Facilitates a connection with peers ...... c. Social fraternities or sororities ...... e. Gives people something to talk about . . . . d. Religious and interfaith groups ...... f.F acilitates male bonding...... e. International and language groups ...... g.Facilitates female bonding ...... f. Minority and ethnic organizations ...... h. Allows people to have more fun ...... g.Political and social action groups ...... i. Gives people something to do ...... h. Music and other performing j. Makes food taste better ...... arts groups ...... k. Makes women sexier ...... i. Student newspaper, radio, TV, l. Makes men sexier ...... magazine, etc...... m. Makes me sexier ...... n.Facilitates sexual opportunities ...... 25.In the first column, indicate whether any of the following have happened to you within the last year while you were 28.On this campus, drinking is a central

in and around campus. alcohol or drugs part in the social life of the following If you answered yes to groups:

Consumed any of these items, indicate Happened (mark one for each line) in the second column if you yesno to y had consumed alcohol or a. Male students ...... other drugs shortly before ou b.F emale students ...... these incidents. c.Faculty/staff ...... yes no yes no d. Alumni ...... a. Ethnic or racial harassment ...... e. Athletes...... b. Threats of physical violence...... f. Fraternities ...... c. Actual physical violence ...... g. Sororities ...... d. Theft involving force or threat If of force ...... yes 29.Campus environment: (mark one for each line) e.F orced sexual touching or fondling ...... a. Does the social atmosphere on this yesno f. Unwanted sexual intercourse ...... campus promote alcohol use? ...... b. Does the social atmosphere promote

26.How do you think your Don’t disappro other drug use? ...... close friends feel (or would c. Do you feel safe on this campus? ...... feel) about you… Disappro disappro Strongly (mark one for each line) 30.Compared to other campuses with which v v v e e e you are familiar, this campus’ use of a.Trying marijuana once or twice ...... alcohol is… (mark one) b. Smoking marijuana occasionally ...... c. Smoking marijuana regularly ...... Greater than other campuses...... d.Trying cocaine once or twice ...... Less than other campuses ...... e.T aking cocaine regularly ...... About the same as other campuses ...... f. Tr ying LSD once or twice ...... g.Taking LSD regularly ...... 31.Housing preferences: (mark one for each line) h.Trying amphetamines once or twice ...... i.Taking amphetamines regularly ...... a. If you live in university housing, do you yesno j.Taking one or two drinks of an live in a designated alcohol-free/ alcoholic beverage (beer, wine, drug-free residence hall? ...... liquor) nearly every day ...... b. If no, would you like to live in such k.Taking four or five drinks nearly every day...... a residence hall unit if it were l. Having five or more drinks in one sitting ...... available? ...... m.Taking steroids for body building or improved athletic performance ......

32.To what extent do students on 37.During the past 30 days, 10 or more times this campus care about to what extent have you Some V Zero times er T 3Ð5 times problems associated with… Not at all engaged in any of the One timew 6Ð9 times Slightly y m o times what (mark one for each line) uch following behaviors? (mark one for each line) a. Alcohol and other drug use ...... a. Refused an offer of alcohol b. Campus vandalism...... or other drugs ...... c. Sexual assault...... b. Bragged about your alcohol d. Assaults that are non-sexual...... or other drug use ...... e. Harassment because of gender ...... c. Heard someone else brag about f. Harassment because of sexual his/her alcohol or other drug use orientation ...... d. Carried a weapon such as a g. Harassment because of race gun, knife, etc. (do not count or ethnicity ...... hunting situations or weapons h. Harassment because of religion ...... used as part of your job) ...... e. Experienced peer pressure 33.To what extent has your 34.To what extent has your to drink or use drugs ...... alcohol use changed within illegal drug use changed f. Held a drink to have people the last 12 months? within the last 12 months? stop bothering you about why Increased ...... Increased ...... you weren’t drinking ...... About the same...... About the same...... g. Thought a sexual partner was Decreased ...... Decreased ...... not attractive because he/she I have not used alcohol . . I have not used drugs . . . . was drunk ...... h.Told a sexual partner that he/she 35.How much do you think people was not attractive because risk harming themselves Moderate r he/she was drunk ......

Slight r Great r (physically or in other ways) Can’t sa No r

if they… (mark one for each line) 38.To what extent do you Strongly disag isk isk isk isk Strongly agree y agree with the following Don’t kno a.Try marijuana once or twice ...... statements? Disag Neutral b. Smoke marijuana occasionally ...... (mark one for each line) Agree ree ree c. Smoke marijuana regularly ...... a. I feel valued as a person w d.Try cocaine once or twice ...... on this campus ...... e. Take cocaine regularly ...... b. I feel that faculty and staff f. Tr y LSD once or twice ...... care about me as a student . . . . g.Take LSD regularly ...... c. I have a responsibility to h.Try amphetamines once or twice ...... contribute to the well-being i.Take amphetamines regularly...... of other students ...... j.Take one or two drinks of an alcoholic beverage d. My campus encourages me (beer, wine, liquor) nearly every day ...... to help others in need ...... k.Take four or five drinks nearly every day ...... e. I abide by the university policy l. Have five or more drinks in one sitting ...... and regulations that concern m.Take steroids for body building or improved alcohol and other drug use . . . . athletic performance...... n. Consume alcohol prior to being sexually active . . . . 39. In which of the following ways does other o. Regularly engage in unprotected sexual activity students’ drinking interfere with your life on with a single partner...... or around campus? (mark one for each line) p. Regularly engage in unprotected sexual activity yesno with multiple partners ...... a. Interrupts your studying ...... b. Makes you feel unsafe ...... 36.Mark one answer for each line: c. Messes up your physical living space (cleanliness, neatness, organization, etc.) yesno a. Did you have sexual intercourse within d. Adversely affects your involvement on the last year? ...... an athletic team or in other organized If yes, answer b and c below. groups...... b. Did you drink alcohol the last time you e. Prevents you from enjoying events had sexual intercourse? ...... (concerts, sports, social activities, etc.) . . c. Did you use other drugs the last f. Interferes in other way(s) ...... time you had sexual intercourse? ...... g. Doesn’t interfere with my life ......

Mark Reflex¨ by NCS MM201109-1 321 Printed in U.S.A.