Inhalants or sniffed substances: During the past 30 Such as glue, gasoline, paint days, how many times thinner, cleaning fluid, or shoe did you use inhalants? polish Prescription drugs without a During the past 30 doctor’s orders: Just to get high days, how many times did you use prescription drugs without a prescription? Think back over your entire lifetime and try to remember whether you have EVER used any of the following substances. If so, what was your age the FIRST TIME you used the substance: Never 10 or 11 12 13 14 15 16 17 or Used Younger Older Cigarettes: Include Ever smoked part or menthol and all of a cigarette? regular cigarettes and loose tobacco rolled into cigarettes Other tobacco Ever used any other products: Include tobacco product? any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe Alcoholic Ever had a drink of beverages: Include an alcoholic beer, wine, wine beverage? Do NOT coolers, malt include any time beverages, and when you only had liquor a sip or two from a drink. Marijuana or Ever used marijuana hashish: Also or hashish? known as grass, pot, hash, or hash oil
Inhalants or sniffed substances: Such as glue, gasoline, paint thinner, cleaning fluid, or shoe polish During the past 30 days, how many times did you use inhalants? Prescription drugs without a doctor’s orders: Just to get high During the past 30 days, how many times did you use prescription drugs without a prescription? Think back over your entire lifetime and try to remember whether you have EVER used any of the following substances. If so, what was your age the FIRST TIME you used the substance: Never Used 10 or Younger 11 12 13 14 15 16 17 or Older Cigarettes: Include menthol and regular cigarettes and loose tobacco rolled into cigarettes Ever smoked part or all of a cigarette? Other tobacco products: Include any tobacco product other than cigarettes such as snuff, chewing tobacco, and smoking tobacco from a pipe Ever used any other tobacco product? Alcoholic beverages: Include beer, wine, wine coolers, malt beverages, and liquor Ever had a drink of an alcoholic beverage? Do NOT include any time when you only had a sip or two from a drink. Marijuana or hashish: Also known as grass, pot, hash, or hash oil Ever used marijuana or hashish?