1.) How old are you? 18
2.) At what age did you begin using ecstasy? 12 or 13
3.) How long have you been using ecstasy? (Indicate if the value represents years, months, weeks or days) 5 years
4.) On how many occasions per every 3 months do you use ecstasy? (indicate if duration between use is longer then 3 months) 1
5.) When you use ecstasy, how many doses do you consume on average for one occasion? 2
6.) Approximately How many doses of ecstasy have u consumed in total since u began using this drug? 30
7.) On how many occasions approximately do you attend a nightclub and or rave event per every 3 months? (indicate if duration is longer then 3 months between attendance) 0
8.) If you frequently smoke ciggarettes, how many do you smoke per week? 40
9.) If you drink alcohol, approximately how many drinks do you consume per month? (One drink is equal to one beer, one cooler, one shot of spirit, or one glass of wine) 100
10.) Other then Alcohol, nicotine, and ecstasy list other street drugs you have previously used? (even if used only once) (ie cocaine, marijuana, mushrooms) Cannabis, Cocaine, Crack, Speed, Heroin, Mushrooms and various legal pills.
11.) Approximately on average what is your disposable monthly income? (how much money do u have available to spend every month) Not alot
2.) At what age did you begin using ecstasy? 12 or 13
3.) How long have you been using ecstasy? (Indicate if the value represents years, months, weeks or days) 5 years
4.) On how many occasions per every 3 months do you use ecstasy? (indicate if duration between use is longer then 3 months) 1
5.) When you use ecstasy, how many doses do you consume on average for one occasion? 2
6.) Approximately How many doses of ecstasy have u consumed in total since u began using this drug? 30
7.) On how many occasions approximately do you attend a nightclub and or rave event per every 3 months? (indicate if duration is longer then 3 months between attendance) 0
8.) If you frequently smoke ciggarettes, how many do you smoke per week? 40
9.) If you drink alcohol, approximately how many drinks do you consume per month? (One drink is equal to one beer, one cooler, one shot of spirit, or one glass of wine) 100
10.) Other then Alcohol, nicotine, and ecstasy list other street drugs you have previously used? (even if used only once) (ie cocaine, marijuana, mushrooms) Cannabis, Cocaine, Crack, Speed, Heroin, Mushrooms and various legal pills.
11.) Approximately on average what is your disposable monthly income? (how much money do u have available to spend every month) Not alot