ok, you asked for it!

Please answer only if you feel comfortable sharing this information. I understand the highly personal nature of both spiritual belief and drug use.
This questionnaire is completely anonymous; I am using it to collect data for a term paper I am writing for an Anthropology class I am taking. Your cooperation is greatly appreciated and will be used solely for academic purposes. The questions are mostly yes/no, but feel free to elaborate on your answers to any of the questions (write in the margins, under the question, where ever!)


1. How old are you? _____

2. What is your race? (circle one) •Caucasian (white) •African-American
Asian/PacificIslander • Other

3. What is your gender? •Female •Male •Other

4. Do you presently inject drugs for recreational purposes, such as heroin, cocaine,
etc.? Y N

5. Have you ever in the past used injected drugs? Y N

6. Do you presently have health insurance? Y N

7. Have you ever been homeless? Y N

8. Where do you usually receive health care? •doctor’s office •public health
clinic •ER •I don’t

9. Do you currently belong to a religion? Y N

10. If so, what is the name of the religion? ____________________________________

11. Do you believe in a god or gods? Y N

12. Do you consider yourself an atheist? Y N

13. Have you belonged to a religion in the past but then “lost faith” in it? Y N

14. Were you raised in a certain religion? Y N

15. What was the name of that religion? _____________________________________

16. Did you attend regular religious services while growing up? Y N

17. Was there any point in your life when you changed religions? Y N

18. If so, how many times have you changed religions? _____

19. Was there any point in your life when you rejected religion or god? Y N

20. If so, did you stay that way, or did you “return” to religion/god? stay return

21. Did you ever experience an event in your life with strong spiritual or religious meaning,
such as a sudden conversion, religious vision, spiritual awakening, etc? Y N

24. Have your religious experiences ever involved the use of drugs? Y N

25. Where did you mainly learn about religion (for example, school, family, frtiends,
books?) _________________________________________________________

26. If you believe in god, do you believe god judges people based on their behavior?
Y N

27. If you believe in god, what is your concept of god? •male •female •god has
no human qualities

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

•god is an inpersonal force that does not communicate with or influence humans. Y N

•god has already passed judgement on humans individually or collectively. Y N

•god’s judgement can be influenced by prayer/moral behavior/good works. Y N

•recreational drugs are part of god’s creation and as such exist for us to use. Y N

•We can never know the mind of god. Y N

•all religions have legitimacy. Y N

•there is only one true religion. Y N

•drugs can give a person access to spiritual insight. Y N

•god is everything and everywhere. Y N

•god has turned his/her/it’s back on mankind. Y N

•god wants people to enjoy themselves. Y N

•my parents gave me no religious guidance. Y N

•my parents were religious fanatics. Y N

•the world would be better place if there were no recreational drugs. Y N

•the world would be a better place if everyone took recreational drugs. Y N

•people are basically good. Y N

•people are basically evil. Y N

•there is a purpose to everyone and everything; everything happens for a reason. Y N

•people have free will. Y N

•all my life I have been searching for spiritual meaning. Y N

•I have found the spiritual meaning to my life. Y N

•finding spiritual meaning is not important to me. Y N

•throughout history, organized religion has been mostly destructive. Y N

•throughout history, organized religion has been mostly beneficial. Y N

•organized religion is not the answer, spiritual enlightenment comes from within. Y N

•I see myself becoming more spiritual in the future. Y N

•I see myself becoming less spiritual in the future. Y N

•see myself staying the same when it comes to spirituality. Y N

Thank you for your time!