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Alcohol Education Workshop Survey


Gender
     




How many nights a week do you think the typical CSB|SJU student parties?
                    

During the previous 3 months, how many days of the week did you typically consume alcohol?
                    
Please answer the next set of questions regarding problems you may have experienced with alcohol use. For each, indicate the most recent time frame you experienced it.
  No Within the past 30 days Within past year
Have you driven a car when you knew you had too much to drink to drive safely?
Have you had a headache/hangover the morning after you had been drinking?
Have you felt very sick to your stomach or thrown up after drinking?
Have you showed up late for work or school because of drinking, a hangover, or an illness caused by drinking?
Have you not gone to work or missed classes at school because of drinking, a hangover or an illness caused by drinking?
Have you gotten into physical fights when drinking?
Have you gotten into trouble at work or school because of drinking?
Have you damaged property, set off a false alarm or other things like that after you had been drinking?
Has your dinking ever created problems between you and your boyfriend/girlfriend or your family?
Has drinking ever gotten you into sexual situations which you later regretted?
Have you ever received a lower grade on an exam or paper than you should have because of your drinking?
Have you ever been arrested or detained, even for a few hours, because of other alcohol-related behaviors?
Have you ever awakened in the morning after a night of drinking and found you could not remember a part of the evening before?
The following questions are designed to identify how you personally feel about your drinking right now. Please think about your current situation and drinking habits, even if you have given up drinking completely. Read each question and decide if you agree or disagree with the statements, then check one of the response boxes for each statement.
  Strongly Disagree Disagree Unsure Agree Strongly Agree
I don’t think I drink too much
I am trying to drink less than I used to
I enjoy my drinking but sometimes I drink too much
Sometimes I think I should cut down on my drinking
It’s a waste of time thinking about my drinking
I have just recently changed my drinking habits
Anyone can talk about wanting to do something about drinking, but I am actually doing something about it
I am at a stage where I should think about drinking less alcohol
My drinking is a problem sometimes
There is no need for me to think about changing my drinking
I am actually changing my drinking habits right now
Drinking less alcohol would be pointless for me
This question assesses two things: 1) What you would expect if you were under the influence of alcohol. 2) Whether you think the effect is good or bad. -- 1)Choose from “disagree” to “agree” depending on whether you expect the effect to happen to you if you were under the influence of alcohol. These effects will vary, depending on the amount of alcohol you typically consume. Please mark one answer after each statement. If I were under the influence from drinking alcohol ...
  Disagree Slightly Disagree Slightly Agree Agree
a) I would be outgoing
b) My senses would be dulled
c) I would be humorous
d) I would have difficulty thinking
e) My head would feel fuzzy
f) I would feel dizzy
g) I would be friendly
h) I would be clumsy
i) I would be loud, boisterous or noise
j) I would be brave or daring
k) I would feel energetic
l) I would act aggressively
m) My responses would be slow
n) My body would be relaxed
o) I would feel moody
p) It would be easier to talk to people
q) I would be talkative
r) I would take risks
s) I would act sociable
2) Choose from “good” to “bad” depending on whether you think particular effect is bad, neutral or good. We want to know if you think a particular effect is bad or good, regardless of whether or not you expect it to happen to you. Please mark one answer after each statement.
  Bad Slightly Bad Neutral Slightly Good Good
a) I would be outgoing
b) My senses would be dulled
c) I would be humorous
d) I would have difficulty thinking
e) My head would feel fuzzy
f) I would feel dizzy
g) I would be friendly
h) I would be clumsy
i) I would be loud, boisterous or noise
j) I would be brave or daring
k) I would feel energetic
l) I would act aggressively
m) My responses would be slow
n) My body would be relaxed
o) I would feel moody
p) It would be easier to talk to people
q) I would be talkative
r) I would take risks
s) I would act sociable


In a typical month, how many...
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Mondays do you typically drink …
Tuesdays do you typically drink …
Wednesdays do you typically drink …
Thursdays do you typically drink …
Fridays do you typically drink …
Saturdays do you typically drink …
Sundays do you typically drink …