ALCOHOL & DRUG ABUSE SURVEY

    Informed Consent

    This assessment is being conducted by the National Youth Council. The assessment is estimated to take less than 5 minutes to complete. Participation is voluntary, and responses will be kept anonymous. Submission of the survey will be interpreted as your informed consent.

    Thank you for your participation in advance!

    Age Bracket?

    County

    [honeypot last-name]

    1. What is the highest level of education you have

    2. What is your marital status?

    3. a) What is your job position?

    b) How long have you worked in the organization?

    c) How would you rate your satisfaction with the working conditions in the organization?

    d) What is the nature of your employment?

    e) In the last one year, have you ever been absent from work because of illness or other reasons?

    f) In the last one year, have you ever gone to a health facility due to any sickness?

    g) In the last one year, have you ever received a warning from your employer for any offence?

    h) In the last one year, have you ever reported to work late?

    i) In the last one year, have you ever been injured in the workplace while operating machinery?

    j) In the last one year, do you know of a colleague who has reported to work drunk?

    k) In the last one year, do you know of a colleague who has been injured while operating machinery while being drunk?

    l) In the last one year, have you ever seen employees using alcohol, drugs or other substances of abuse?

    m) In the last one year, have you ever been stressed in the workplace due to the nature of your work?

    n) If yes, please mention the stressors that you have encountered at the workplace in the last one year.

    4. a) Have you ever taken any alcoholic drink, that is, bottled beer or spirit, traditional brew or illicit liquor?

    b) In the last one year, have you ever taken any alcoholic drink?

    5. During the last one year, have you experienced any of the following signs or symptoms as a result of alcohol use? respond to all the questions

    a)Have you had times when you ended up using alcohol more, or longer, than you intended?

    b)Have you more than once wanted to cut down or stop using alcohol but couldn’t?

    c)Have you spent a lot of time using alcohol or being sick or recovering from the effects (hangover) of alcohol?

    d)Have you ever wanted alcohol so badly that you couldn’t think of anything else?

    e)Have you ever found that using alcohol or being sick from using alcohol often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

    f)Have you continued to use alcohol even though it was causing trouble with your family or friends?

    g)Have you given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to use alcohol?

    h)Have you more than once gotten into situations after using alcohol that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a
    dangerous area, or having unsafe sex)?

    i)Have you continued to use alcohol even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

    j)Have you ever had to use more alcohol than you once did to get the effect you want?

    k)Have you found that when the effects of alcohol were wearing off, you had withdrawal 7.11 symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing
    heart, or a seizure? Or sensed things that were not there?

    6. a)In the last 30 days, have you taken any alcoholic drink (bottled beer, wine, spirit, traditional brew etc.)?

    b)Who do you usually drink with? (Please provide one response)

    c)Do you take any alcoholic drink or report on duty drunk?

    d)Have you ever tried to stop using alcohol?

    7. a)Have people annoyed you by criticizing your drinking?

    b)Have you ever felt you needed to cut down on your drinking?

    c)Have you ever felt guilty about drinking?

    d)Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

    8.a) Have you ever, even once, used any of these drugs?
    {Tobacco products (Cigarettes, Snuff/ chewed/ piped tobacco, Kuber, Shisha)}

    Marijuana/ bhang

    Khat (Miraa/ muguka)

    Heroin (brown sugar)

    Cocaine (coke, crack)

    Inhalants (petroleum products/ glue)

    Prescription drugs for non – medical reasons e.g. cozepam, Valium, diazepam, rohypnol, codeine e.t.c.

    b) Which of these drugs have you used in the past 12 months?

    c) Which of these drugs have you used in the past one month?

    d) Which of these drugs do you use daily?

    9.Would you consider stopping using any drug or substance of abuse that you currently use?

    10.a) How would you describe the level of alcohol
    and drug abuse in the organization?

    b) Are you aware of any activities undertaken in the organization to address alcohol and drug abuse problem at the workplace?

    c) During the past year, how many times have you attended a training/ sensitization on alcohol and drug abuse?

    d) Which areas or topics would you recommend to be included in trainings/sensitizations organized by the organization on alcohol and drug abuse?

    e)In the last one year, have you seen any messages on alcohol and drug abuse within the workplace? E.g. charts, banners etc.

    f)During the past year, how many times have you received any awareness information, education and communication (IEC) material on alcohol and drug abuse?

    g)Are you aware of existence of counseling and treatment services for people with substance use disorder/ addiction in the organization?

    h)Are you aware of existence of an alcohol and drug abuse workplace policy in the organization?

    i)What would you recommend to be included in the organization’s ADA policy to better address issues related to substance abuse?

    11. a)How would you rate your satisfaction with the organization in regard to the effectiveness of its alcohol and drug abuse prevention?
    Fully SatisfiedSatisfiedSomewhat satisfiedDissatisfiedVer dissatisfiedNot aware

    b)How would you rate your satisfaction with regard to early identification of people with substance use disorders?
    Fully SatisfiedSatisfiedSomewhat satisfiedDissatisfiedVer dissatisfiedNot aware

    c)How would you rate your satisfaction with the support for people with substance use disorders?
    Fully SatisfiedSatisfiedSomewhat satisfiedDissatisfiedVer dissatisfiedNot aware

    d)How would you rate your overall satisfaction with the performance of the organization regarding its alcohol and drug abuse prevention program?
    Fully SatisfiedSatisfiedSomewhat satisfiedDissatisfiedVer dissatisfiedNot aware

    12. a)Do you know of a place or facility where a person can be helped to stop drug abuse?

    b)What are the names of drug rehabilitation place/facility that you know?

    13. a)Do you know any of your colleague(s) with an alcohol or drug abuse problem?

    b)Does any member of your family abuse alcohol or drugs of abuse? (In this context, family member means spouse, sibling, children or parents)

    c)Does their drug problem affect your work performance?

    14.Do you agree or disagree with the following statements?

    a) Alcohol and drug abuse is a private affair and should not be addressed at the workplace

    b) People who perform poorly due to their drug abuse problem should be dismissed from work

    c) Alcoholism or drug addiction is a disease like any other and so addicts should be assisted in every way

    d) Our organization should have a resident drug abuse counselor to help addicts to quit the habit

    15.Which are some of the factors that influence the use of alcohol and drugs of abuse in the organization?

    16.What should be done to improve the organization’s Employee Assistance Programme e.g. prevention, early identification, referral, counselling, treatment and rehabilitation programs?

    17.What can you do to support the organization in controlling alcohol and drug abuse at the workplace?

    18.Please share additional comments or suggestion on how the organization can improve its alcohol and drug abuse prevention program.