Section 4: Drugs.

43 Questions.

Have you ever done any of the following:

132. had an alcoholic drink?

YES NO

133. been intoxicated?

YES NO

134. thrown up from having drunk too much alcohol?

YES NO

135. passed out due to having drunk too much alcohol?

YES NO

136. forgotten events that occurred while you were drunk?

YES NO

137. smoked tobacco? (cigarette, pipe, cigar, hookah)

YES NO

138. chewed tobacco? (snuff)

YES NO

139. bought controlled/illicit drugs, or any compound scheduled by the DEA, in violation of the law?

YES NO

140. sold or re-sold controlled/illicit substances, or any compound scheduled by the DEA, in violation of the law?

YES NO

141. taken stimulants?

YES NO

142. taken depressants excluding alcohol?

YES NO

143. inhaled nitrous oxide while not visiting a dentist?

YES NO

144. inhaled anything containing butyl nitrate?

YES NO

145. used a commercial aphrodisiac? (Spanish Fly, Magic Love Drops, powdered rhino horn, etc.)

YES NO

146. taken valium?

YES NO

147. smoked marijuana/sensemilia?

YES NO

148. smoked marijuana/sensemilia more than four times?

YES NO

149. eaten marijuana/sensemilia?

YES NO

150. eaten marijuana or sensemilia more than four times?

YES NO

151. taken opiate in any form?

YES NO

152. taken opiate in any form more than twice?

YES NO

153. used cocaine?

YES NO

154. used cocaine more than four times?

YES NO

155. injected any drugs into your body for any other purpose other than medical?

YES NO

156. injected any one drug into your body for any purpose other than medical more than twice?

YES NO

157. taken Ecstasy/X?

YES NO

158. taken PCP?

YES NO

159. taken PCP more than twice?

YES NO

160. taken d-lysergic acid diethylamide (LSD-25), peyote, or psilocybin?

YES NO

161. taken LSD, peyote, or psilocybin more than twice?

YES NO

162. taken LSD more than six times?

YES NO

163. deliberately injured yourself so as to obtain medication?

YES NO

164. played any games in which there was a mystery as to who would be getting drugs and who wouldn't, yet everybody plays in it? (e.g. "Who's got the pill", where half the cups (of soda) have LSD in them and the other half don't, and everybody picks a cup and drinks it and wonders who gets lucky.)

YES NO

165. gone to class or work while under the influence of drugs? (alcohol counts)

YES NO

166. mixed drugs? (alcohol counts. Mixed meaning being under the influence of two or more drugs at once.)

YES NO

167. sold possessions in order to obtain drugs?

YES NO

168. had sex while under the influence of nitrous?

YES NO

169. had an orgasm while under the influence of nitrous? (difficult because of timing)

YES NO

170. had sex while under the influence of cocaine?

YES NO

171. had sex while under the influence of marijuana/sensemilia?

YES NO

172. had sex while under the influence of Ecstasy/X?

YES NO

173. had sex while under the influence of LSD, peyote, or psilocybin?

YES NO

174. had sex while under the influence of drugs with a partner who did not realize you were on them?

YES NO