| 1. 1. Have you ever ridden a vehicle whose driver (including yourself) was "high" and under the influence of drugs or alcohol? |
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| 2. 2. Have you ever used alcohol or drugs to relax or to feel better about yourself in order to fit in socially? |
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| 3. 3. Have you ever forgotten things because of alcohol and drugs usage? |
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| 4. 4. Have you ever used alcohol or drugs because you were alone? |
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| 5. 5. Has your family or your friends ever told you that you should reduce alcohol and drugs consumption? |
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| 6. 6. Have you ever found yourself in trouble when you used drugs or alcohol? |
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