.svg){kind=small}
Drug Addiciton Survey
The survey is designed to gather information about people's experiences with drug addiction. The survey will ask about your personal experiences with drug addiction, as well as your thoughts on the subject. The survey is anonymous and confidential, and your answers will be used to help researchers better understand drug addiction and its impact on people's lives.
2 minutes to complete
Eligibility
Anyone who has struggled with drug addiction is eligible to fill out this survey.
Questions for Drug Addiciton Survey
Questions for Drug Addiciton Survey
How often do you use drugs?
- Never
- Rarely
- Daily
- Weekly
- Occasionally
What types of drugs do you use?
How much do you typically use?
How often do you experience negative consequences as a result of your drug use?
- Often
- Sometimes
- Seldom
- Never
Have you ever experienced withdrawal symptoms when you stopped using drugs?
- Yes
- No
Have you ever sought professional help for your drug use?
- Yes
- No
How do you feel about your current drug use?
Similar Scales
Explore AllTobacco Motives Inventory
This is a 15-item self-report measure that assesses motives for cigarette smoking. Response choices are on a 5-point Likert scale ("not at all true" to "very true"). Adolescents are asked to rate each potential motive for smoking with respect to how true they think it is. There are four subscales for the 15-item measure. These include Social Motives (4 items), Self-enhancement Motives (4 items), Boredom Relief Motives (2 items), and Affect Regulation Motives (5 items).
Stanford Smoking Dependence Inventory
The SDI is a 5-item modified version of the Fagerstrom Tolerance Questionnaire for use with adolescent smokers. Modifications include rescaling items to provide more response options and analyzing daily cigarette consumption separately.
Jacksons Smoking Susceptibility
Jackson's Smoking Susceptibility is a scale used to describe the likelihood of a child's (in grade 3 to grade 5) smoking susceptibility in 2 years.
Smoking Consequences Questionnaire
The Smoking Consequences Questionnaire is a tool used to assess the possible consequences of someone's smoking habits. The questionnaire is designed to help individuals identify areas of their life that may be negatively impacted by their smoking habits.
The Cigarette Dependence Scale
The Cigarette Dependence Scale (CDS) is a self-report measure used to assess an individual’s level of nicotine dependence on cigarettes. It assesses the intensity of physical and psychological dependence and the frequency of smoking.
Nicotine Dependence Questionnaire For Adolescents
The Nicotine Dependence Questionnaire for Adolescents (NDSA) contains questions about nicotine dependence in adolescents. It has questions about the intensity and severity of nicotine use in terms of dependence symptoms, such as craving, withdrawal, and tolerance.
Drug Abuse Screening Test
The Drug Abuse Screening Test (DAST) is a 10-question, self-report survey used to detect potential substance abuse. This test is intended to identify any potential use of illicit drugs, as well as the abuse of prescription drugs.
Alcohol Use Disorders Identification Test
Because alcohol use can affect your health and can interfere with certain medication and treatments, it is important that we ask some questions about your use of alcohol.
Drug Use Questionnaire
The purpose of this questionnaire is to provide a brief, simple, practical but valid method of identifying individuals who are abusing psychoactive drugs. It also yields a quantitative index score of the degree of problems related to drug use and drug misuse.
Drug Addiciton Survey
The survey is designed to gather information about people's experiences with drug addiction. The survey will ask about your personal experiences with drug addiction, as well as your thoughts on the subject. The survey is anonymous and confidential, and your answers will be used to help researchers better understand drug addiction and its impact on people's lives.
Alcohol Addiction Survey
The purpose of this survey is to gather information about people's experiences with alcohol addiction. The survey will ask about your personal experiences with alcohol addiction, as well as your thoughts on the causes, treatments, and consequences of addiction.
Am I An Alcoholic Test
Drinking casually with friends for fun doesn’t seem alcoholic; the classic picture of an alcoholic is someone whose life is falling apart, doesn’t have a job, or stealing money to drink. But this is not true; someone who looks pretty perfect and functional from the outer can be alcoholic.
FAQs on Drug Addiciton Survey
- Drug addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. Drug dependence is a physical dependence on a particular drug that leads to withdrawal symptoms when the drug is stopped.
Want to use this template?
What people say
Join 500+ happy customers worldwide who are already using our amazing product.
Beyond Surveys—A Truly Multi-Purpose Tool
This platform goes far beyond basic surveys. I’ve used it for lead generation, landing page enrichment, and even embedded videos. Everything’s easy to use, well documented, and super flexible—whether you're building forms, quizzes, or something more advanced.
Martin G.Créateur de la Méthode RashōmonUI/UX is great and fast API processing
I think BlockSurvey is good for short and long surveys. What I find the best is the fact that there are so many templates I can use and customize.
Ankit M.AI Analyst Team LeadAI form builder for top security and data privacy
Uses end-to-end encryption technology that allows users to create survey forms where data is secure and private. UI looks very beautiful.
Lou F.Creative VisionaryNothing Like It — BlockSurvey Is in a League of Its Own!
From end-to-end encryption-level security and AI-generated questions to powerful logic flows and white-label domains, BlockSurvey has it all. It’s secure, innovative, and packed with features like calculations, templates, and in-app analytics. I use it to create personalized assessments for leadership training—nothing else compares.
Kim B.Founder/ President - International Leadership TrainerSurvey and Forms for Privacy and Security
BlockSurvey puts privacy and security above anything else. The use of end-to-end encryption is not a gimmick as in many products; it's a core feature enabling privacy and security. The survey building tools are impeccable. I've used numerous SaaS survey tools, and nothing comes close.
Trevor L.Chief Information Security Officer (CISO)Big fan of BlockSurvey and what Wilson and the team are doing. BlockSurvey was the end-to-end encrypted product I signed up for and I love the UI, privacy, responsiveness, and transparency behind the platform. Great job all 'round and awesome to see it keep evolving.
James Longley@jameslongleyUnmatched Security & Stunning Response Rates
Few tools combine data confidentiality and form aesthetics like this one. The conversational design improved my response rate by 43%, and the webhook integrations made syncing to our CRM effortless. I also love how responsive and community-driven the support team is.
Kris R.Group Automation ManagerPowerful custom surveys
Creating surveys with BlockSurvey has been a breeze. The drag-and-drop interface is intuitive, and we’re able to collect data anonymously and securely—without intermediaries. It’s interactive, friendly, and encourages high participation while protecting user privacy. The reports are solid, and we’ve used it confidently for internal and external feedback.
Liz D.IT Support SpecialistPrivate, Beautiful Surveys That Build Trust
For our NGO, data privacy is everything—and this platform nails it. It keeps personal info fully protected while letting us design beautiful, chat-like surveys that increase engagement. Team collaboration features sealed the deal.
Luis Noel D.Director Comercial