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PROTECTOR FACTORS ON SUBSTANCE ABUSE PATTERNS
Author: Misael Rehbain
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This study explores the protective factors of substance abuse patterns and the psychological symptoms as a result of the use of drugs. This is an American based research project being undertaken as part of a Masters of Education degree at Cambridge College, MA. This survey asks questions about substance use. Anyone is allowed to participate in this study. Data submitted will not be traced back to individuals by the researchers.
First you will be asked some general demographic questions such as your age, your education level and your occupational status. Then you will be asked to complete a questionnaire on your drug use history. You will also be asked how do you feel about substance use and if you have any concerns about your drug use. Then you will be asked specifically about substance use and other questions to put them in a scale between “strongly agree” to “strongly disagree”.
The approximate time to complete the questionnaire is 15 minutes; however there is no set time limit. Participation is anonymous and voluntary and you are free to withdraw at any time. Your completion of this questionnaire will be taken as your consent to participate. All information is confidential and will remain the property of the investigators. Any findings of the study will be reported as group findings and no individual will be identifiable.
Demographic Information:
1    What is your gender?
Male Female
2    What is your age?
3    What is your date of birth?

(MM/DD/YYYY)
4    What is your race?
5    What is your education level?
Primary Secondary High School
University
Postgraduate please specify:
6    What is your relationship status?
Single Married Separate Divorced
7    Where do you currently reside?
e.g. at home with parents//in foster care
8    Where is your country?
9    Are you currently employed?
Yes
No please specify:
10    What kind of job?
11    I am currently a member of the church?
Yes No
12    What is your religious affiliation?
Catholic Baptist Presbyterian
Methodist Other
Church services attended:
13    Per week
1 2 3 4 5 6 7
14    Per month
1 2 3 4 5 6 7 8 9 10
+ please specify:
15    Per year
1 2 3 4 5 6 7 8 9 10
+
16    What kind sports do you like?
Drug use history:
17    Are you or your friends recreationally use:
Cigarettes
Marijuana or other Cannabis derivates
Alcohol
Diet pills / Caffeine pills
prescription drugs (not prescribed by doctor)
Steroids
Cocaine
Hallucinogens
Ecstasy
Amphetamines
Heroin
18    What kind drug you use?
19    Amount that you use
20    Frequency you use
21    Age first started
22    Reason for using
General concern about drug use:
23    How do you or your friend feel about drug use?
Drug’s don’t make me feel as good as I used to feel in the past.
I feel I am addicted.
I must consume increasing dosage to get the same effect as used to get in the past.
I feel loss of control.
I put myself at risk after using drugs (driving, etc.).
I am damaging my body when I use drugs.
I am damaging my brain when I use drugs.
I feel “down” after the effect of drugs is gone.
Other please specify:
Please rate each sentence on the scale:
(1-Strongly agree, 2-Agree, 3-Neutral, 4-Disagree, 5-Strongly disagree)
1 2 3 4 5please specify:
24My friends and I think its fine to use drugs and drink recreationally.
25My family’s religion is very important to them, and they passed these beliefs down to me.
26Illegal substances and alcohol are easy to obtain.
27Even though it’s hard to admit, I feel like I don’t spend enough time with my parents.
28My family’s religion is very important to them, and they passed these beliefs down to me.
29I could come to school high and no one would notice or say anything.
30My parents can tell when I’d drunk and they give me a hard time about it.
31I consider myself to be a very spiritual person.
32My interest in sports keeps me from using drugs, because it will impact my performance.
33I have been in trouble in school as a result of my drug use.
34There is a God.
35I am very actively involved in school events.
36Drinking and drug use are common amongst my friends.
37I try to follow the teachings of my religion.
38Drinking and drug use are common in my family.
39I have noticed some medical problems which I think might be a result of my drug use.
40My faith gives me the belief that even though things are hard, they will turn out OK.
41I have close friends that I feel I can talk to about anything.
42I try to find time to do my homework every day.
43My spiritual beliefs keep me from using or limit my drug use.
44My family and I have a strained relationship.
45I feel like my friends and I can go out and have a good time even when not high or drunk.
46Church services keep me or someone I know from using drugs.
47I think that the music I listen to influences my decision to use drugs.
48I feel guilty when I use drugs even when I don’t get caught.
49If you have a faith, God will help you or someone you know to NOT use drugs.
50Members of my immediate family have substance abuse issues.
51I have had legal troubles as a result of my substance use.
52Even though I use drugs, I feel that it is immoral to do so.
53Most people can quit drinking and using drugs any time they want to.
54When tragedies strike, people can find real comfort in their faith.
55I think that addiction is genetic and there’s nothing you can do about it.
56I can still be an “A” student and use drugs recreationally.
57Sometimes I feel that if I work a little harder, God will finally forgive me.
58I tend to NOT use drugs because it interferes with sports.
59I don’t think school is worth the effort because I’m not going to succeed anyway.


Questions with '*' sign must be answered

   

Please note your answers will be open to public.
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