| ENTRY SPECIFICATION |
{"name": "ASSIST-NIDA",
taken for reasons or in doses other than prescribed. You will also be asked
(Note: For prescription medications, please report nonmedical use only.) ",
{"question": "q6942", "operator": "EQ", "value": "c217",
"skips":["q6952","q6962","q6972"]},
{"question": "q6943", "operator": "EQ", "value": "c217",
"skips":["q6953","q6963","q6973"]},
{"question": "q6944", "operator": "EQ", "value": "c217",
"skips":["q6954","q6964","q6974"]},
{"question": "q6945", "operator": "EQ", "value": "c217",
"skips":["q6955","q6965","q7309"]},
{"question": "q6946", "operator": "EQ", "value": "c217",
"skips":["q6956","q6966","q6976"]},
"columns": 2,
{"question": "q6947", "operator": "EQ", "value": "c217",
"skips":["q6957","q6967","q6977"]},
{"question": "q7174", "operator": "EQ", "value": "c237",
"skips":["q7175","q7167","q7169","q7170","q7171","q7172","q7173"]}]
}
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6930", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1b. Cocaine (coke, crack, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
about illicit or illegal drug use - but only to better diagnose and treat you.
"columns": 2,
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6931", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1c. Prescription stimulants (Ritalin, Concerta, Dexedrine, Adderall, diet pills,
etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
For each substance, select the appropriate frequency of use. For example, if you
"columns": 2,
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6932", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1d. Methamphetamine (speed, crystal meth, ice, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
have used cocaine monthly in the past year, select Monthly for illegal drugs.<br
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6933", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1e. Inhalants (nitrous oxide, glue, gas, paint thinner, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
/><br />In the past year, how often have you used the following? "
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6934", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1f. Sedatives or sleeping pills (Valium, Serepax, Ativan, Xanax, Librium,
Rohypnol, GHB, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
},
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6935", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1g. Hallucinogens (LSD, acid, mushrooms, PCP, Special K, ecstasy, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "q6925", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q6936", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1h. Street opioids (heroin, opium, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
"text": "1. Alcohol (for men, 5 or more drinks a day or for women, 4 or more drinks a
]},
{"id": "q6937", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1i. Prescription opioids (fentanyl, oxycodone [OxyContin, Percocet], hydrocodone
[Vicodin], methadone, buprenorphine, etc.)",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
day)",
]},
{"id": "q7174", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "1j. Other",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
"intro": "Following are a few questions that will help us give you better medical care. The
{"id": "q7175", "type": "StringQuestion", "required": false, "inline": true,
"text": " Specify:",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"controlWidth": 200, "min": 0, "max": 0},
{"id": "q6939", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2a. In the past three months, how often have you used cannabis (marijuana, pot,
grass, hash, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"restartDays": 2,
questions relate to your experience with alcohol, cigarettes, and other drugs.
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6940", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2b. In the past three months, how often have you used cocaine (coke, crack,
Some of the substances listed are prescribed by a doctor (like pain
etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
medications). You are only asked to record those you have taken for reasons or
]},
{"id": "q6941", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2c. In the past three months, how often have you used prescription stimulants
(Ritalin, Dexedrine, Adderall, diet pills, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
in doses other than prescribed. You will also be asked about illicit or illegal
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6942", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2d. In the past three months, how often have you used methamphetamine (speed,
crystal meth, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
drug use - but only to better diagnose and treat you. For each substance,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6943", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2e. In the past three months, how often have you used inhalants (nitrous oxide,
gas, paint thinner, etc.)?",
select the appropriate frequency of use. For example, if you have used cocaine
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
monthly in the past year, select Monthly for illegal drugs.<br /><br />In the
{"id": "q6944", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2f. In the past three months, how often have you used sedatives or sleeping pills
(Valium, Serepax, Ativan, Librium, Xanax, GHB, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
past year, how often have you used the following? ",
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6945", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2g. In the past three months, how often have you used hallucinogens (LSD, acid,
PCP, Special K, ecstasy, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"columns": 2,
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6946", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2h. In the past three months, how often have you used street opioids (heroin,
opium, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
"choices":[
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6947", "type": "ChoiceQuestion", "required": false, "inline": true,
"printTitle": "Alcohol Smoking and Substance Involvement Screening - NIDA modified version",
{"id": "c217", "text": "0. Never", "quickKey": 0},
"text": "2i. In the past three months, how often have you used prescription opioids
(fentanyl, oxycodone, [OxyContin], hydrocodone [Vicodin],methadone,
buprenorphine, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q7167", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2j. In the past three months, how often have you used other substances (as
specified above)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6949", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3a. In the past 3 months, how often have you had a strong desire or urge to use
cannabis (marijuana, pot, grass, hash, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6950", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
"text": "3b. In the past 3 months, how often have you had a strong desire or urge to use
cocaine (coke, crack, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
]},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6951", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3c. In the past 3 months, how often have you had a strong desire or urge to use
prescribed amphetamine type stimulants (Ritalin, Dexedrine, Adderall, diet
pills, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "q6926", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6952", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3d. In the past 3 months, how often have you had a strong desire or urge to use
methamphetamine (speed, crystal meth, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
"text": "2. Tobacco Products",
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6953", "type": "ChoiceQuestion", "required": false, "inline": true,
"intro": "Following are a few questions that will help us give you better medical care. The
"text": "3e. In the past 3 months, how often have you had a strong desire or urge to use
inhalants (nitrous oxide, gas, paint thinner, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
questions relate to your experience with alcohol, cigarettes, and other drugs.
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6954", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3f. In the past 3 months, how often have you had a strong desire or urge to use
sedatives or sleeping pills (Valium, Serepax, Ativan, Librium, Xanax, GHB,
etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"content":[
Some of the substances listed are prescribed by a doctor (like pain
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6955", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3g. In the past 3 months, how often have you had a strong desire or urge to use
hallucinogens (LSD, acid, PCP, Special K, ecstasy, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
medications). You are only asked to record those you have taken for reasons or
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6956", "type": "ChoiceQuestion", "required": false, "inline": true,
in doses other than prescribed. You will also be asked about illicit or illegal
"text": "3h. In the past 3 months, how often have you had a strong desire or urge to use
street Opioids (heroin, opium, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
drug use - but only to better diagnose and treat you. For each substance,
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6957", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3i. In the past 3 months, how often have you had a strong desire or urge to use
prescribed opioids (fentanyl, oxycodone [OxyContin], hydrocodone [Vicodin],
methadone, buprenorphine, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
select the appropriate frequency of use. For example, if you have used cocaine
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q7169", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3j. In the past 3 months, how often have you had a strong desire or urge to use
other substances (as specified above)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
monthly in the past year, select Monthly for illegal drugs.<br /><br />In the
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6959", "type": "ChoiceQuestion", "required": false, "inline": true,
past year, how often have you used the following? ",
"text": "4a. During the past 3 months, how often has your use of cannabis (marijuana, pot,
grass, hash, etc.) led to health, social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
"columns": 2,
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6960", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4b. During the past 3 months, how often has your use of cocaine (coke, crack,
etc.) led to health, social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
"choices":[
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6961", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4c. During the past 3 months, how often has your use of prescribed amphetamine
type stimulants (Ritalin, Dexedrine, Adderall, diet pills, etc.) led to health,
social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
{"id": "c217", "text": "0. Never", "quickKey": 0},
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6962", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "i2177", "type": "IntroText",
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
"text": "4d. During the past 3 months, how often has your use of methamphetamine (speed,
crystal meth, etc.) led to health, social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6963", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4e. During the past 3 months, how often has your use of inhalants (nitrous oxide,
gas, paint thinner, etc.) led to health, social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6964", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4f. During the past 3 months, how often has your use of sedatives or sleeping
pills (Valium, Serepax, Ativan, Librium, Xanax, GHB, etc.) led to health,
social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6965", "type": "ChoiceQuestion", "required": false, "inline": true,
]},
"text": "4g. During the past 3 months, how often has your use of hallucinogens (LSD, acid,
PCP, Special K, ecstasy, etc.) led to health, social, legal or financial
problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "q6927", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6966", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4h. During the past 3 months, how often has your use of street opioids (heroin,
opium, etc.) led to health, social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"text": "3. Prescription Drugs for Non-Medical Reasons",
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6967", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4i. During the past 3 months, how often has your use of prescribed opioids
(fentanyl, oxycodone [OxyContin], hydrocodone [Vicodin], methadone,
buprenorphine, etc.) led to health, social, legal or financial problems? ",
"intro": "Following are a few questions that will help us give you better medical care. The
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
questions relate to your experience with alcohol, cigarettes, and other drugs.
{"id": "q7170", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4j. During the past 3 months, how often has your use of other substances (as
specified above) led to health, social, legal or financial problems?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
Some of the substances listed are prescribed by a doctor (like pain
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6969", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5a. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of cannabis (marijuana, pot, grass, hash,
etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"text": "Instructions:<br />Following are a few questions that will help us give you
medications). You are only asked to record those you have taken for reasons or
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6970", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5b. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of cocaine (coke, crack, etc.)?",
in doses other than prescribed. You will also be asked about illicit or illegal
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
drug use - but only to better diagnose and treat you. For each substance,
{"id": "q6971", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5c. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of prescribed amphetamine type stimulants
(Ritalin, Dexedrine, Adderall, diet pills, etc.)? ",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
select the appropriate frequency of use. For example, if you have used cocaine
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6972", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5d. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of methamphetamine (speed, crystal meth
etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
monthly in the past year, select Monthly for illegal drugs.<br /><br />In the
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6973", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5e. During the past 3 months, how often have you failed to do what was normally
past year, how often have you used the following? ",
expected of you because of your use of inhalants (nitrous oxide, gas, paint
thinner, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
"columns": 2,
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6974", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5f. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of sedatives or sleeping pills (Valium,
Serepax, Ativan, Librium, Xanax, GHB, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q7309", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5g. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of hallucinogens ( LSD, acid, PCP, Special
K, ecstasy, etc.)?",
{"id": "c217", "text": "0. Never", "quickKey": 0},
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "q6976", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5h. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of street Opioids (heroin, opium, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
better medical care. The questions relate to your experience with alcohol,
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q6977", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5i. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of prescribed opioids (fentanyl, oxycodone
[OxyContin], hydrocodone [Vicodin], methadone, buprenorphine, etc.)? ",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
{"id": "q7171", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5j. During the past 3 months, how often have you failed to do what was normally
expected of you because of your use of other substances (as specified above)?",
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c217", "text": "0. Never", "quickKey": 0},
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
]},
]},
{"id": "q6979", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6a. Has a friend or relative or anyone else ever expressed concern about your use
of cannabis (marijuana, pot, grass, hash, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
{"id": "q6928", "type": "ChoiceQuestion", "required": false, "inline": true,
]},
{"id": "q6980", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6b. Has a friend or relative or anyone else ever expressed concern about your use
of cocaine (coke, crack, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
"text": "4. Illegal Drugs",
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6981", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6c. Has a friend or relative or anyone else ever expressed concern about your use
of prescribed amphetamine type stimulants (Ritalin, Dexedrine, Adderall, diet
pills, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"intro": "Following are a few questions that will help us give you better medical care. The
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6982", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6d. Has a friend or relative or anyone else ever expressed concern about your use
of methamphetamine (speed, crystal meth, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
questions relate to your experience with alcohol, cigarettes, and other drugs.
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6983", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6e. Has a friend or relative or anyone else ever expressed concern about your use
of inhalants (nitrous oxide, gas, paint thinner, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
Some of the substances listed are prescribed by a doctor (like pain
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6984", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6f. Has a friend or relative or anyone else ever expressed concern about your use
of sedatives or sleeping pills (Valium, Serepax, Xanax, Ativan, Librium, GHB,
etc.)?",
medications). You are only asked to record those you have taken for reasons or
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6985", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6g. Has a friend or relative or anyone else ever expressed concern about your use
cigarettes, and other drugs. Some of the substances listed are prescribed by a
in doses other than prescribed. You will also be asked about illicit or illegal
of hallucinogens (LSD, acid, PCP, Special K, ecstasy, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6986", "type": "ChoiceQuestion", "required": false, "inline": true,
drug use - but only to better diagnose and treat you. For each substance,
"text": "6h. Has a friend or relative or anyone else ever expressed concern about your use
of street opioids (heroin, opium, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
select the appropriate frequency of use. For example, if you have used cocaine
{"id": "q6987", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6i. Has a friend or relative or anyone else ever expressed concern about your use
of prescribed opioids (fentanyl, oxycodone [OxyContin], hydrocodone [Vicodin],
methadone, buprenorphine, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
monthly in the past year, select Monthly for illegal drugs.<br /><br />In the
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q7172", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6j. Has a friend or relative or anyone else ever expressed concern about your use
of other substances (as specified above)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
past year, how often have you used the following? ",
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6989", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7a. Have you ever tried and failed to control, cut down or stop using cannabis
(marijuana, pot, grass, hash, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"columns": 2,
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6990", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7b. Have you ever tried and failed to control, cut down or stop using cocaine
(coke, crack, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6991", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7c. Have you ever tried and failed to control, cut down or stop using prescribed
amphetamine type stimulants (Ritalin, Dexedrine, Adderall, diet pills, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
{"id": "c217", "text": "0. Never", "quickKey": 0},
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6992", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7d. Have you ever tried and failed to control, cut down or stop using
methamphetamine (speed, crystal meth, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
{"id": "c256", "text": "1. Once or twice", "quickKey": 1},
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6993", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7e. Have you ever tried and failed to control, cut down or stop using inhalants
(nitrous oxide, gas, paint thinner, etc.)?",
{"id": "c228", "text": "2. Monthly", "quickKey": 2},
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6994", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7f. Have you ever tried and failed to control, cut down or stop using sedatives
doctor (like pain medications). You are only asked to record those you have
{"id": "c229", "text": "3. Weekly", "quickKey": 3},
or sleeping pills (Valium, Serepax, Xanax, Ativan, Librium, GHB, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6995", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c230", "text": "4. Daily or almost daily", "quickKey": 4}
"text": "7g. Have you ever tried and failed to control, cut down or stop using
hallucinogens (LSD, acid, PCP, Special K, ecstasy, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
]},
{"id": "q6996", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7h. Have you ever tried and failed to control, cut down or stop using street
opioids (heroin, opium, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
{"id": "i2178", "type": "IntroText",
]},
{"id": "q6997", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7i. Have you ever tried and failed to control, cut down or stop using prescribed
opioids ( fentanyl, oxycodone [OxyContin], hydrocodone [Vicodin], methadone,
buprenorphine, etc.)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
{"id": "c275", "text": "0. No, never", "quickKey": 0},
"text": "1. In your Lifetime, which of the following substances have you ever used? <br />
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q7173", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7j. Have you ever tried and failed to control, cut down or stop using other
substances (as specified above)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
(Note: For prescription medications, please report nonmedical use only.) "
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]},
{"id": "q6999", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "8. Have you ever used any drug by injection (NONMEDICAL USE ONLY)?",
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
(Note: For prescription medications, please report nonmedical use only.) ",
"columns": 2,
"choices":[
},
{"id": "c275", "text": "0. No, never", "quickKey": 0},
{"id": "c2397", "text": "1. Yes, but not in the past 3 months", "quickKey": 1},
{"id": "c2396", "text": "2. Yes, in the past 3 months", "quickKey": 2}
]}],
"rules":[
{"question": "q6927", "operator": "EQ", "value": "c217",
"conjunction": "and", "question2": "q6928", "operator2": "EQ", "value2": "c217",
"skips":["q6929","q6930","q6931","q6932","q6933","q6934","q6935","q6936",
"q6937","q6939","q6940","q6941","q6942","q6943","q6944","q6945","q6946",
"q6947","q7167","q6949","q6950","q6951","q6952","q6953","q6954","q6955",
{"id": "q6929", "type": "ChoiceQuestion", "required": false, "inline": true,
"q6956","q6957","q7169","q6959","q6960","q6961","q6962","q6963","q6964",
"q6965","q6966","q6967","q7170","q6969","q6970","q6971","q6972","q6973",
"q6974","q7309","q6976","q6977","q7171","q6979","q6980","q6981","q6982",
"q6983","q6984","q6985","q6986","q6987","q7172","q6989","q6990","q6991",
"q6992","q6993","q6994","q6995","q6996","q6997","q7173","q6999","q7174",
"q7175"]},
{"question": "q6929", "operator": "EQ", "value": "c237",
"skips":["q6939","q6949","q6959","q6969","q6979","q6989"]},
{"question": "q6930", "operator": "EQ", "value": "c237",
"skips":["q6940","q6950","q6960","q6970","q6980","q6990"]},
"text": "1a. Cannabis (marijuana, pot, grass, hash, etc.)",
{"question": "q6931", "operator": "EQ", "value": "c237",
"skips":["q6941","q6951","q6961","q6971","q6981","q6991"]},
{"question": "q6932", "operator": "EQ", "value": "c237",
"skips":["q6942","q6952","q6962","q6972","q6982","q6992"]},
{"question": "q6933", "operator": "EQ", "value": "c237",
"skips":["q6943","q6953","q6963","q6973","q6983","q6993"]},
{"question": "q6934", "operator": "EQ", "value": "c237",
"skips":["q6944","q6954","q6964","q6974","q6984","q6994"]},
{"question": "q6935", "operator": "EQ", "value": "c237",
"skips":["q6945","q6955","q6965","q7309","q6985","q6995"]},
"intro": "1. In your Lifetime, which of the following substances have you ever used? <br />
{"question": "q6936", "operator": "EQ", "value": "c237",
"skips":["q6946","q6956","q6966","q6976","q6986","q6996"]},
{"question": "q6937", "operator": "EQ", "value": "c237",
"skips":["q6947","q6957","q6967","q6977","q6987","q6997"]},
{"question": "q6939", "operator": "EQ", "value": "c217",
"skips":["q6949","q6959","q6969"]},
{"question": "q6940", "operator": "EQ", "value": "c217",
"skips":["q6950","q6960","q6970"]},
{"question": "q6941", "operator": "EQ", "value": "c217",
"skips":["q6951","q6961","q6971"]},
|
