QUESTIONNAIRE ON BASELINE SURVEY ON ALCOHOL AND DRUG ABUSE

(ADA) AMONG TRAINERS FROM TERTIARY INSTITUTIONS IN KENYA

QUESTIONNAIRE NO. ___________

INSTRUCTIONS

The Performance Contracting Guidelines requires that all Tertiary Institutions to undertake a “Baseline Survey
on Alcohol and Drug Abuse to promote evidence-based programming.

The data captured by this questionnaire is meant to assist in designing evidence-based strategies for
addressing the challenges of alcohol and drug abuse among trainers in tertiary institutions.

Please note that the information you provide will be treated with utmost confidentiality. The institution takes all
necessary precautions to ensure that the information you give will only be used for the intended purpose. The
questionnaire is also anonymous and your name, course or department will not be required. All that is needed
is your honest feedback to assist the institution to respond to the needs of affected trainers.

Please read and answer all the questions.

Thank you.

For official use only

Date

Edited by

Keyed in by

Date keyed in

1
No. QUESTIONS RESPONSES
Section 1: Background and characteristics of respondents
1. Male
101. What is your gender?
2. Female
How old are you?
102. Write age in complete years ...................................... years
Record the dates (Day/Month/Year):
103. What is your date of birth?
.........................................
1. Christian
2. Muslim
104. What is your religion?
3. Hindu/Buddhist
4. Other (Specify)...............................................
1. More than four years
2. Three years
105. Year of Service?
3. Two years
4. One year
1. Accommodation within the institution
2. Accommodation outside the institution
106. Type of your Accommodation
3. Reside from home
4. Other (Specify) ……………………………………………………………………
Section 2: Availability and Accessibility of Drugs and Substances of Abuse
SUBSTANCE Yes No
1. Alcohol
2. Cigarettes
3. Kuber/ Tamboo
4. Shisha
5. Snuff/ Ugoro/ Chaves/ Mbaki
Which of the following drugs 6. Miraa/ Muguka/ Jaba
and substances of abuse are 7. Bhang/ Marijuana/ Shash
201. commonly used in this 8. Weed Cookies/ Weed Cakes/ Weed Edibles
institution? 9. Heroin/ Kete/ Kichuri/ Brown
10. Cocaine/ Crack/ White Powder
11. Codeine and Cough Syrups abused to get “high”
12. Prescription drugs e.g. Cozepam/ C/ Yellow/ Maduya,
Artane/ Benzhexol/ Rohypnol/ Diazepam/ Bughizi/ Valium/
Largactil/ Ma White/ Ma Blue
13. Inhalants e.g. jet fuel, gasoline, thinner, glue etc.
Slightly Very
SUBSTANCE Very Easy Easy Difficult
Easy Difficult
1. Alcohol
2. Cigarettes
3. Kuber/ Tamboo
How easy is it to obtain the
4. Shisha
202. following substances within the 5. Snuff/ Ugoro/ Chaves/ Mbaki
institution? 6. Miraa/ Muguka/ Jaba
7. Bhang/ Marijuana/ Shash
8. Weed Cookies/ Weed Cakes/
Weed Edibles
9. Heroin/ Kete/ Kichuri/ Brown
10. Cocaine/ Crack/ White Powder
2
 No. QUESTIONS RESPONSES
11. Codeine and Cough Syrups
abused to get “high”
12. Prescription drugs e.g.
Cozepam/ C/ Yellow/ Maduya,
Artane/ Benzhexol/ Rohypnol/
Diazepam/ Bughizi/ Valium/
Largactil/ Ma White/ Ma Blue
13. Inhalants e.g. jet fuel, gasoline,
thinner, glue etc.
SECTION 3: Drugs and Substance Use
A. Which of the B. Which of the B. Which of the C. Which of the
following listed drugs following listed following listed drugs following listed drugs
have you ever taken drugs have you have you ever taken have you ever taken in
in your lifetime ever taken in the in the last one year the last one (1) month
(Tick as appropriate last one year (Tick as appropriate (Tick as appropriate
for all the drugs) (Tick as for all the drugs) for all the drugs)
appropriate for all
the drugs)
SUBSTANCE Yes No Yes No Yes No
1. Alcohol
2. Cigarettes
3. Kuber/ Tamboo
4. Shisha
5. Snuff/ Ugoro/ Chaves/ Mbaki
301. 6. Miraa/ Muguka/ Jaba
7. Bhang/ Marijuana/ Shash
8. Weed Cookies/ Weed Cakes/
Weed Edibles
9. Heroin/ Kete/ Kichuri/ Brown
10. Cocaine/ Crack/ White Powder
11. Codeine and Cough Syrups
abused to get “high”
12. Prescription drugs e.g. Cozepam/
C/ Yellow/ Maduya, Artane/
Benzhexol/ Rohypnol/ Diazepam/
Bughizi/ Valium/ Largactil/ Ma
White/ Ma Blue
13. Inhalants e.g. jet fuel, gasoline,
thinner, glue etc.
Section 4: Sources of Drugs and Substances of Abuse
YES NO
1. Canteen/ Bar/ Premise within the Institution
2. Canteen/ Bar/ Premise within the
Where do trainers in this institution Neighborhood
401. obtain drugs and substances of abuse? 3. From fellow students within the institution
[Tick ALL as appropriate] 4. From friends
5. From school workers
6. From lecturers and tutors
7. From Parents

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No. QUESTIONS RESPONSES
8. Others (specify)
......................................................................................................................................
Yes No
1. Any time
2. During lecture breaks
When are trainers from this institution 3. After evening lectures
most likely to use drugs and substances 4. Weekends
402. of abuse? 5. During inter-college/ university competitions
[Tick ALL as appropriate] 6. University/ College trips
7. During holidays/ semester breaks
8. Others (specify)
........................................................................................................................................
Are you aware of trainers in this
1. Yes
403. institution who are selling bhang/
2. No
marijuana within the institution?
Are you aware of trainers in this
1. Yes
404. institution who are selling heroin or
2. No
cocaine within the institution?
Are you aware of trainers in this
institution who are selling prescription
405. drugs e.g. cozepam/ C/ yellow/ artane/ 1. Yes
benzhexol/ rohypnol/ diazepam/ bughizi/ 2. No
valium/ largactil/ ma white/ ma blue
within the institution?
Are you aware of trainers in this
1. Yes
406. institution who are selling bhang/
2. No
marijuana within the neighbourhood?
Are you aware of trainers in this
1. Yes
407. institution who are selling heroin or
2. No
cocaine within the neighbourhood?
Are you aware of trainers in this
1. Yes
408. institution who are selling prescription
2. No
drugs within the neighbourhood?
Do you know any trainer who has been
1. Yes
409. found in possession of drugs and
2. No
substances of abuse in this institution?
YES NO
1. Referred to Guidance/Counselling
2. Parents/Guardians are summoned to the institution
3. Referred to peer counselling
What usually happens to trainers found
410. in possession of drugs or substances of 4. Referred to treatment and rehabilitation
abuse? 5. Suspended from the institution
[Tick all applicable] 6. Taken to the police
7. Expelled from the institution
8. Others (specify)
.....................................................................................................................................
...........
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No. QUESTIONS RESPONSES
Section 5: Risk Factors and Consequences of Drugs and Substances of Abuse
Do you have a parent/ guardian who 1. Yes
501. use drugs and substances of abuse? 2. No
Do you have a friend who uses drugs 1. Yes
502. and substances of abuse? 2. No
Have you ever failed to set and
administer an exam
503. of continuous assessment in the last 1. Yes
one year? 2. No
Have you ever missed a class or lecture 1. Yes
504. in the last one year? 2. No
Have you ever had a disciplinary issue
505. with administration in the last 1. Yes
one year? 2. No
Are there adequate efforts by
management in your institution to 1. Yes
506. control access and use of drugs and 2. No
substances of abuse by trainers?
Have you ever participated in a forum of
drugs and substance abuse awareness 1. Yes
507. and prevention program in your 2. No
institution?
508. Are you an active member in any 1. Yes
religious group? 2. No
Are you an active member of any sport 1. Yes
509. or club? 2. No
Have you ever been screened for drugs
1. Yes
510. and substances of abuse in this
2. No
institution?
Section 6: Strategies on Drugs and Substance Abuse Prevention
Program YES NO
1. Awareness talks on drugs and substance abuse
2. Guidance/Counselling services
Which of the following programs are 3. Sobriety clubs or clubs on prevention of substance abuse
601. offered in this institution to address the 4. Peer counselling
problems of drugs and substance 5. Referral of students to treatment and rehabilitation services
abuse? 6. Random checks for drugs and substances of abuse
7. Policy on drug free environment within the institution
8. Sensitization programs for first year students
9. A core unit on drugs and substance abuse in first year
_______________________________________________________________________
Which other programs are being offered
_______________________________________________________________________
602. in this institution to address the
problems of drugs and substance _______________________________________________________________________
abuse?
_______________________________________________________________________

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No. QUESTIONS
What would you recommend the
University/ College/Institution
Management, Parents/ Guardians,
603
Lecturers and Neighboring Communities
to do in in the prevention of drugs and
substances of abuse?
THANK YOU FOR YOUR TIME
RESPONSES
University/ College/ Institution Management
1. ..............................................................................................................................
2. ..............................................................................................................................
3. ..............................................................................................................................
Parents
1. ……………………………………………………………………………………………
2. ……………………………………………………………………………………………
3. ……………………………………………………………………………………………
Lecturers
1. ..............................................................................................................................
2. ..............................................................................................................................
3. ..............................................................................................................................
Neighboring Communities
1. ..............................................................................................................................
2. ..............................................................................................................................
3. ..............................................................................................................................