Did you use any of the following drugs in the past 12 months? Marijuana

Which drugs or intoxicants, if any, have you ever tried? Inhalants

Which drugs or intoxicants, if any, have you ever tried? Cocaine

How often have you used any of these drugs or intoxicants in the last 12 months? Heroine

How often have you used any of these drugs or intoxicants in the last 12 months? Ecstasy

How often have you used any of these drugs or intoxicants in the last 12 months? Amphetamines

How often have you used any of these drugs or intoxicants in the last 12 months? Anti-depressants (w/o Prescription)

How often have you used any of these drugs or intoxicants in the last 12 months? Tobacco

How often have you used any of these drugs or intoxicants in the last 12 months? Sedatives (w/o Prescription)

How often have you used any of these drugs or intoxicants in the last 12 months? Cocaine Paste