A survey on addiction in your community.

A survey on addiction in your community.

Please answer these questions according to how you feel about addiction in your community, and how it has impacted you.
Have you lost a friend or family member to an substance use related event such as an overdose?*

YesNo
Have you heard of Naloxone, sometimes called Narcan?*

YesNo
Do you regularly carry Naloxone on you?

YesNo
If it was easy to access, would you be willing to carry Naloxone or have it somewhere readily available?

YesNo
If you are willing to share, what reservations do you have about carrying Noloxone or having it readily available?
If you are willing, please select how you feel about the following statements. Otherwise you can skip to the bottom of this survey.
I am concerned about substance use disorders in my community.

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
I feel my community could use more resources for substance use recovery.

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
I would prefer that my community invests more into the following:

Substance Use Treatment & RecoveryDrug Law EnforcementA Mixture of Both
Safety programs for overdoses and needles are valuable to the community.

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
I have the resources and knowledge to educate children about substance use disorders and recovery.

Strongly AgreeAgreeNeutralDisagreeStrongly Disagree
If you would like to share any additional thoughts about substance use disorders and recovery in your community or your experiences with substance use, please type it out below, every bit of information helps us make more informed decisions for our community.
What is your zip code?*
What age bracket best describes you?*

Below the age of 20Age 20 - 30Age 31 - 45Age 46-65Age 65+
If you would like to be entered into our giveaway to community members please enter your email address below. All surveys will remain anonymous and treated as highly confidential.
example@example.com
Should be Empty:

A survey on addiction in your community.

If you are willing, please select how you feel about the following statements. Otherwise you can skip to the bottom of this survey.