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*This is a reproduction of the questionnaire used for collecting the data of the present study. The instructions for filling out the questionnaire and the covering letter that went out with it are reproduced in Chapter 3.
| NO NAMES! | ||
| Age_____ | Occupation_______________ (if a student, what do you plan?) | |
| Sex_____ | Marital Status_____ | |
| Education: degree or highest grade completed__________________________________________ | ||
| Do you have any children?_____ | Political affiliation_____________________________________ | |
| Religious affiliation______________________ | ||
| Ever been arrested?_____ | For what?___________________________________________ | |
| Were you convicted?__________________________________ | ||
| Do you regularly practice any sort of meditation or other non-drug discipline for spiritual or personal growth?______________ | ||
| If so, what?_____________________________________________________________________ | ||
| How long have you been smoking pot or hash?_______________________ | ||
| In all this time, what has been your average frequency of use? (ignore this question if you've been turning on less than 6 months) | _____Almost every day or more _____Once/week or more _____Once/month or more _____Occasionally | |
| During the last six months, what has been your frequency of use? | _____Almost every day or more _____Once/week or more _____Once/month or more _____Occasionally | |
| How often have you used any of the following major psychedelics: LSD, mescaline, peyote, psilocybin, DMT, or DET? | ||
| Before you started smoking pot? | _____More than 6 (how many?) _____One to five times _____Never | |
| After you started smoking pot? | _____More than 6 (how many?) _____One to five times _____Never | |
| Within the last six months? | _____More than 6 (how many?) _____One to five times _____Never | |
| Please make the same ratings (before, after, last 6 months) by putting three numbers (N-N-N) after each of the drugs below you have tried: | ||
| Amphetamine or methedrine (by mouth) Amphetamine or methedrine (by injection) | ||
| STP PEACE | MDA Others (what?) | |
Do you think your experiences (if any) with any of these other psychedelic drugs have affected or changed the quality of your experiences with pot? If yes, how?
How long have you been drinking alcoholic beverages in sufficient quantity to change your consciousness (i.e., drinking to get "tipsy" or drunk, rather than just having a little wine or beer with meals for the taste)?
In all this time, what has been your average frequency of use?
During the last six months, what has been your average frequency of use?
If pot were as available legally as alcohol. about what percentage of the time would you choose alcohol to alter your state of consciousness rather than pot?
[HTML editor's note: To save space and transmission time, the following change has been made: With a few exceptions, all the following questions should have the same list of choices following them as question number 1. The exceptions are followed by the choices as contained in the original publication.]
1. I can see new colors or more subtle shades of color than when I'm straight.
Frequency? Never Rarely Sometimes Very Often Usually How Stoned? Just Fairly Strongly Very Strongly Maximum LSD
2. Colors get duller, not as vivid.
3. There is a sensual quality to vision, as if I were somehow "touching" the objects or people I am looking at.
4. When I look at pictures they may acquire an element of visual depth, a third dimensional aspect that they don't have when straight.
5. The world looks flat; it lacks the third dimension of depth.
6. I see fringes of colored light around people (not objects), what people have called the "aura."
7. I see fringes of colored light around objects (not people), what people have called the "aura."
8. If I try to visualize something, form a visual image, I see it in my mind's eye more intensely, more sharply than when straight.
9. Things outside the center of my visual field, things in the periphery of my vision look different when I'm not looking directly at them than when I look directly at them. E.g., I might see a door as open when I'm not looking directly at it but when I look directly at it, it is closed.
10. Things seen are seen more sharply in that their edges, contours stand out more sharply against the background.
11. My vision tends to be somewhat blurry, if I try to examine something visually, I can't focus quite as sharply as when straight.
12. My visual perception of the space around me is changed so that what I'm looking at is very real and clear, but everything else I'm not focusing on visually seems further away or otherwise less real or clear.
13. I can see patterns. forms, figures, meaningful designs in visual material that does not have any particular form when I'm straight, that is just a meaningless series of lines or shapes when I'm straight.
14. Visual depth perception changes, so that near objects seem much nearer and far objects seem much further away.
15. Objects or people may seem to get visually nearer or further as I look at them without their actually moving at all.
16. The face of another person will change even as I watch it, so he keeps changing from one different person to another.
17. Everything I look at seems to vibrate or pulse, as if it had a life of its own.
18. I find it difficult to read while stoned.
19. It is easier to read than usual while stoned.
20. If I read while stoned, I remember more of what I've read hours later than if I had been straight.
21. If I read while stoned, I remember less of what I've read hours later than if I had been straight.
22. I have more imagery than usual while reading; images of the scenes I'm reading about just pop up vividly.
23. With my eyes open, I can see things that aren't there, i.e., for which there is no real visual basis. For example. if you look at stains on a wall and see a design, that's an illusion; you are altering something there. This question deals with seeing something when there's nothing there, such as seeing a pattern or object on a perfectly blank wall.
24. I can hear more subtle changes in sounds; e.g.. the notes of music are purer and more distinct, the rhythm stands out more.
25. I can understand the words of songs which are not clear when straight.
26. I have difficulty hearing things clearly: sounds are blurry and indistinct.
27. If I try to have an auditory image, hear something in my mind, remember a sound, it is more vivid than when straight.
28. The sound quality of my own voice changes, so that I sound different to myself when I talk.
29. When listening to stereo music or live music, the spatial separation between the various instruments sounds greater, as if they were physically further apart.
30. With my eyes closed and just listening to sounds, the space around me becomes an auditory space, a place where things are arranged according to their sound characteristics instead of visual geometrical characteristics.
31. Touch sensations take on new qualities that they don't have when straight.
32. My sense of touch is more exciting, more sensual, when stoned.
33. Some surfaces feel much smoother, silkier than when straight.
34. Some surfaces feel much rougher, more irregular, than when straight; the
35. Objects seem heavier, more massive, when I lift them when stoned.
36. Objects seem lighter, less massive, when I lift them.
37. I can experience vivid tactual imagery, imagine what things feel like and feel their texture very vividly in my mind.
38. The temperature of things, their warmth or coldness, takes on new qualities.
39. Taste sensations take on new qualities that they don't have when straight.
40. Tastes become divided into several components. instead of an overall taste. E g., a bite of bread may taste salty on one part of your tongue and sour on another part at the same time.
41. There is an exceptionally long time delay between starting to chew food and the time the taste actually reaches my consciousness.
42. I salivate quite a lot when stoned.
43. If I belch, I retaste the food in my stomach. and it tastes very good.
44. I enjoy eating very much and eat a lot.
45. If I try to imagine what something tastes like, I can do so very vividly.
46. I crave sweet things to eat, things like chocolate, more than other foods.
47. Smell sensations take on new qualities that they don't have when straight.
48. Smells become much richer and more unique when stoned.
49. When I smell something, different components of the smell seem to register at different physical locations in my nose.
50. If I try to imagine what something smells like, I can do so much more vividly than when straight.
51. When I walk someplace my experience of the distance covered is quite changed (e.g., not being aware of the space between. just seeming to suddenly be there or, conversely, feeling that it takes an immense number of steps to cover the distance).
52. Distances between me and things or me and other people seem to get greater: they are further away.
53. Distances between me and other things or people seem to get shorter; they are closer.
54. Objects seem to tilt toward the left.
55. I get so lost in fantasy or similar trips in my head that I completely forget where I am, and it takes a while to reorient after I come back and open my eyes.
56. The space or air around me takes on a solid quality; it is no longer "empty" space.
57. The force of gravity seems to alternate between pushing me up and pushing me down.
58. Time passes very slowly; things go on for the longest (e.g., one side of a record seems to play for hours).
59. Time passes very rapidly; things finish almost before they seem to have gotten started.
60. Time seems to stop; it's not just that things take longer, but certain experiences seem outside of time, are timeless.
61. Events and thoughts flow more smoothly; the succession of events in time is smoother than usual.
62. Events and thoughts follow each other jerkily; there are sudden changes from one thing to another.
63. While something is happening, I get the funny feeling that this sequence has happened before. in exactly the same way. Even though I logically know it couldn't have happened before, it feels strange, as if it's repeating exactly (this is called a deja vu experience and should not be confused with a false memory).
64. I believe in the existence of extrasensory perception (ESP),
i.e., that people can sometimes acquire knowledge about things
happening at a distance in space or time, or about other people's
thoughts, when there is no possibility of this knowledge having
been acquired through the known senses (sight, hearing, etc.).
_____Believe strongly
_____Believe somewhat
_____Haven't made up my mind
_____Disbelieve somewhat
_____Disbelieve strongly
65. I feel so aware of what people are thinking that it must be telepathy, mind reading, rather than just being more sensitive to the subtle cues in their behavior. Frequency?
66. I can foretell the future by some kind of precognition, more than just predicting logically from present events.
67. Have you ever had the experience of feeling "located"
outside your physical body, i.e. of you being at a different
location in space than the one you knew your body was at? Dreams
aren't included here, or situations where you just lose consciousness
of your body. This is where you consciously feel located at a
different place and know at the time that you are
conscious but at a different location. Has this happened to you:
At all____ (if so please describe on rear)
While stoned? ____happened before/after started smoking grass.
68. I can perform magical operations that will affect objects or people while stoned. (Please describe on rear)
69. My perception of how my body is shaped gets strange; the "felt" shape or form doesn't correspond to its actual form (e.g., you may feel lopsided, or parts of your body feel heavy while others feel light).
70. I lose awareness of most of my body unless I specifically focus my attention there, or some particularly strong stimulus demands my attention there.
71. If I am paying attention to some particular part of my body, the rest of my body fades away a lot so the part I'm attending to stands out more sharply.
72. When there is any trembling in my body, the upper half of my body trembles much more than the lower half.
73. I become very aware of my breathing and can feel the breath flowing in and out of my throat as well as filling my lungs.
74. I get dizzy or nauseated, so much so that I wonder if I will get sick.
75. I become aware of parts of my body that I am normally unaware of! can't become aware of when straight, such as internal organs.
76. My body gets very numb, without feeling.
77. The location of my consciousness, the physical locale of the part of me that seems most me, has moved to different parts of my physical body from those it occupies while straight.
78. When defecating or urinating, I become aware of the internal organ processes involved that I can't be aware of when straight.
79. With my eyes closed, my body may feel very light or even feel as if I float up into the air when stoned.
80. My body feels abnormally heavy, as if it weighed much much more.
81. I feel a lot of pleasant warmth inside my body.
82. I get feelings in my body that are best described as energy, force, power of some sort flowing.
83. I become very aware of my spine and feel energy flowing through it.
84. I become aware of chakra centers along my spine and feel changes in my state of consciousness as energy flows through the chakras.
85. I feel a vibration or tingling sensation in some or all of my body that I can tell is not an actual muscle tremor by looking at my body.
86. My muscles develop actual physical tremors (large enough to see visually).
87. My scalp itches a lot if I have smoked too much grass.
88. Pain is easy to tolerate if I keep my attention elsewhere.
89. Pain is more intense if I concentrate on it.
90. My body feels larger than usual.
91. My body feels smaller than usual.
92. I am much more aware of the beating of my heart.
93. I have lost all consciousness of my body and the external world, and just found myself floating in limitless space (not necessarily physical space).
94. I have lost all consciousness of my body during fantasy trips, i.e., gotten so absorbed in what was going on in my head that my body might as well not have existed for a while.
95. I feel much stronger when stoned (regardless of whether actually physically stronger or weaker).
96. I feel much weaker when stoned (regardless of whether actually physically stronger or weaker).
97. My non-dominant hand (left if you're right-handed and vice-versa) becomes partially paralyzed, unusable.
98. I get physically restless so that I want to move around a lot.
99. I get physically relaxed and don't want to get up or move around.
100. When I move about or dance, my motions seem exceptionally smooth and well coordinated.
101. When I move about or dance, my motions seem awkward and uncoordinated.
102. I tremble a lot in my hands for a while after having been stoned.
103. My sense of balance gets very erratic, making it seem difficult to walk or even maintain a sitting position.
104. Smoking grass makes me cough hard while inhaling and holding my breath.
105. When stoned with others, I play "childish" games; i.e., we interact with each other in ways which are very enjoyable but which people would ordinarily consider childish.
106. I find it very hard to play ordinary social games when stoned.
107. I feel isolated from things around me, as if there were some kind of barrier or glass wall between me and the world, muting everything coming in and partially isolating me.
108. I get somewhat paranoid about the people with me; I am suspicious about what they're doing.
109. I am less noisy and boisterous at parties than when straight.
110. I am less noisy and boisterous at parties than when drunk or tipsy on alcohol.
111. I feel the things I say in conversation when stoned are more profound, more appropriate to the conversation, more interesting.
112. When stoned with a group of people, the group takes on a much greater sense of unity, of real social relationship, than when straight; i.e., I feel much more part of a group instead of one person simply in the presence of other people.
113. I have feelings of deep insights into other people, how they tick, what their games are, when stoned (regardless of whether they check out later).
114. I empathize tremendously with others; I feel what they feel; I have a tremendous intuitive understanding of what they're feeling.
115. I become more sociable; I want to be with and interact with people more.
116. I become less sociable; I want to be by myself.
117. I talk a lot more than when straight.
118. I talk a lot less than when straight.
119. Other people seem dead, lifeless, as if they were robots when I'm stoned.
120. I am very strongly influenced by the social situation set up by my companions, so I will do whatever they are doing even if it is something I don't want to do or wouldn't do normally.
121. Being with people who are much higher than I am (as from their being on acid or much more stoned on grass) gets me higher even though I don't smoke any more grass.
122. My sexual drive goes up when stoned; I have more need for sex.
123. I have much less sexual drive when stoned; it's difficult to arouse me even in a situation which would normally arouse me.
124. I have no increase in sexual feelings unless it's a situation that I would normally be sexually aroused in, and then the sexual feelings are much stronger and more enjoyable.
125. When making love, I feel I'm in much closer mental contact with my partner; it is much more a union of souls as well as bodies.
126. When making love, I feel rather isolated from my partner; I'm wrapped up in my intensified sensations and not really very aware of my partner's reactions and feelings.
127. I feel as if I'm a better person to make love with when stoned. Why? (Please answer on back.)
128. Sexual orgasm has new qualities, pleasurable qualities, when stoned.
129. I can get so wound up in thoughts or fantasies that I won't notice what's going on around me or won't hear someone talking to me unless they attract my attention forcibly.
130. I can get so wound up in thoughts or fantasies while doing some physical task or job that I lose awareness of doing it, yet suddenly find that I have finished the physical task even though I lost track of it mentally.
131. I do things with much less thought to possible consequences of my actions than when straight, i.e., I go ahead and do things without thinking first about "What will people think? How will this effect me?" etc.
132. My mind goes completely blank for long periods (15 minutes or more); even though I'm not asleep, I have no thoughts or images or anything going on m my mind.
133. In thinking about a problem of the sort that normally requires a series of steps to solve, I can get the answer without going through some of the usual intermediate steps; i.e., I start to think about the problem and then just arrive at what is clearly the answer, without being aware of the steps in the thought process I would normally be aware of.
134. I can't think clearly; thoughts keep slipping away before I can quite grasp them.
135. Commonplace sayings or conversations seem to have new meanings, more significance.
136. I give little or no thought to the future; I'm completely in the here-and-now.
137. I am more willing to accept contradictions between two ideas or two views of the situation than when straight. I don't get up tight because the two things don't make immediate sense.
138. I learn a great deal about psychological processes, what makes people tick, i.e., general knowledge about how the mind works (as opposed to specific insights about yourself).
139. Spontaneously, insights about myself, my personality, the games I play come to mind when stoned, and seem very meaningful.
140. If I deliberately work on it I can have important insights about myself, my personality, the games I play.
141. If I try to solve a problem, it feels as if my mind is working much more efficiently than usual (regardless of how you evaluate your solution later).
142. If I try to solve a problem it feels as if my mind is much less efficient than usual (regardless of how you evaluate the solution later).
143. If I work on some problem while stoned, I work more accurately than straight, as judged by later real-world evaluation.
144. If I work on some problem while stoned, I work less accurately than straight, as judged by later real-world evaluation.
145. The ideas that come to my mind when stoned are much more original than usual.
146. I appreciate very subtle humor in what my companions say, and say quite subtly funny things myself.
147. I can play elaborate games and get very involved in the games.
148. When thinking about things while stoned, there are visual images that just automatically go along with the thinking; i.e., I think much more in images instead of just abstract thoughts.
149. I think about things in ways that seem intuitively correct, but which do not follow the rules of logic.
150. I spontaneously remember things I hadn't thought of in years, more so than straight (does not apply to consciously trying to remember things.)
151. My memory for otherwise forgotten events is much better than straight when I consciously try to remember.
152. My memory for otherwise forgotten events is much worse than when straight when I try to remember.
153. My memory span for conversations is somewhat shortened, so that I may forget what the conversation is about even before it has ended (even though I may be able to recall it if I make a special effort).
154. My memory span for conversations is very shortened so that I may forget what the start of a sentence was about even before the sentence is finished (although I may be able to recall it if I make a special effort).
155. I can continue to carry on an intelligent conversation even when my memory span is so short that I forget the beginnings of what I started to say; e.g., I may logically complete a sentence even as I realize I've forgotten how it started.
156. I think I've said something when actually I've only thought about saying it, more so than when straight.
157. I think something is a memory when it turns out to be a fantasy, something I just made up, but fooled myself into thinking was a memory at the time. (not the same as deja vu.)
158. My memory of what went on while I was stoned is good afterwards, better than if I had been straight all the time.
159. My memory of what went on while I was stoned is poor afterwards compared to what I would have remembered had I been straight.
160. Whatever mood I was in before turning on becomes greatly amplified, so if I felt down I really feel bad and if I felt good I really feel very good.
161. I feel emotions much more strongly when stoned, so they affect me more.
162. I feel emotions much more weakly when stoned, so they have little effect on me.
163. I am more aware of the body tensions and feelings that are part of emotions when stoned.
164. I am less aware of the body tensions and feelings that are part of emotions when stoned.
165. I almost invariably feel good when I turn on, regardless of whether I felt bad before turning on.
166. I almost invariably feel bad when I turn on, regardless of how I felt before I turned on.
167. How many people have you seen "freak out" on grass,
i.e., have such a catastrophic emotional upset that they needed
help of some sort? (Not counting yourself.) _____No. of People
What percentage is this compared to all the times you've seen
people get stoned?
168. What sort of help did they get? How effective was it?
169. Have you ever freaked out in this way? _____Yes _____No
How many times?_____
What sort of help did you get, and how effective
was it?
170. I find it easy to accept whatever happens; I don't need to control it or feel in control of it.
171. I worry about losing control, such that I might do something I wouldn't want to do (regardless of whether you actually lose control).
172. I lose control of my actions and do antisocial things (actions that harm other people) that I wouldn't normally do.
173. My inhibitions are lowered so that I do things I'm normally too inhibited to do (Note: this does not apply to antisocial acts but to acts that are generally acceptable, but that you can't normally do through shyness or the like).
174. I giggle a lot when stoned; I am silly, even though the situation is not that funny.
175. I often forget to finish some task I've started, or get sidetracked more frequently than when straight.
176. I get a rather compulsive desire to get even higher after a certain stage; I will smoke much more if I can
177. I have little or no control over my fantasies; i.e., they flow along spontaneously
and even If I try I can't change what I'm fantasying about.
178. I have excellent control over my fantasies; I can make them go in whatever
direction I want.
179. I can work at a necessary task with extra energy, absorption, and efficiency.
180. I have lost control and been "taken over" by an outside force or will, which is hostile or evil in intent, for a while.
181. I have lost control and been "taken over" by an outside force or will, which is good or divine, for a while.
182. Parts of my body have moved on their own volition, have done something which I did not will.
183. I feel as if I lose control over my thoughts; they just go on regardless of what I want (without reference to whether you like this or not).
184. I can "come down" at will if I need to be straight for a minute to deal with some complicated reality problem (circle the point of highness above which you can't do this).
185. My personality changes a lot temporarily while I'm stoned, so that in many important ways I am a different person for that time.
186. I have burn so absorbed in looking at or contemplating an object or person that I felt as if I were that object or person, i.e.. temporarily the split between it-and-me or they-and-me was transcended.
187. When stoned I lose most of my sense of ego identity and usually take on 3; the identity of my like-sexed parent (father for males, mother for females).
188. I feel completely unique; there is no one like me; I feel as if I am much better than ordinary people when stoned.
189. I lose all sense of self, of being a separate ego, and feel at one with the world.
190. I feel very powerful, capable, and intelligent when stoned.
191. Some events become archetypal, part of the basic way Man has always done things. That is, instead of me (John Doe, ego) doing something, it is just Man Doing What Man Has Always Done. That is, my actions become part of the pattern that man has always been part of, instead of me, a particular individual, carrying out a particular act at a particular moment in space/time.
192. I feel in touch with a Higher Power or a Divine Being to some extent when stoned, I feel more in contact with the "spiritual" side of things.
193. I am able to meditate more effectively than when straight (if yes, please describe what sort of meditation you do on the back of this page).
194. I have spiritual experiences, discrete experiences which have had a powerful, long-term religious effect on me while stoned. (If so, please describe on rear.) ____Yes _____No
195. Getting stoned has acquired a religious significance for me. ____Yes _____No (If yes, in what way? Explain on back.)
196. I find it very difficult to get to sleep if I'm stoned, even if it's my usual bedtime.
197. I find it very easy to go to sleep at my usual bedtime when stoned.
198. I get very drowsy even though it's not late or otherwise close to my usual bedtime.
199. My sleep is particularly refreshing if I go to bed stoned.
200. My sleep is restless and poor if I go to bed stoned.
201. My dreams are more vivid if I go to bed stoned.
202. My dreams are less vivid or forgotten if I go to bed stoned.
203. Since taking LSD (or mescaline, peyote, psilocybin, or another
major psychedelic drug), I am able to get much higher on grass than I was before.
_____Yes
_____No
_____Not applicablehaven't had LSD
204. I have special ways of getting higher besides smoking more
grass with:
1. Other drugs + grass _____Yes _____No
2. Special mental techniques _____Yes _____No
(Please explain any yes answer on rear)
205. There is a certain degree of being stoned from above which I cannot come down quickly if I must come down to deal adequately with reality. (circle level)
206. I have special technique(s) for coming down rapidly if I
need to be straight quickly.
_____Yes _____No (If yes, please describe on rear)
207. I feel more childlike, more open to experience of all kinds, more filled with wonder and awe at the nature of things.
208. Some of my inner trips, eyes-closed fantasies have been so vivid and real that, even though I know logically they couldn't be real, they feel real; they are as real as ordinary waking-life experience.
209. I find it very hard to get organized or accomplish anything I want to the day after smoking grass (Circle lowest level at which this occurs.)
210. I have gotten very nauseous and vomited.
211. Others (who were straight at the time) have told me that I act very differently when I'm stoned. (Circle highest level at which this has happened.)
212. Others (who were straight at the time) have not noticed that I've been stoned (applies to other people who were your friends and would have told you if they'd noticed). (Circle highest level at which this has happened.)
213. Could you compare the effects of alcohol and marijuana on yourself on the back of this page? When do you prefer to use the one, when the other?
214. I feel that the world is all right. that everything is pretty much the way it should be when stoned (except for the marijuana laws)
215. I feel the world is in pretty bad shape, that all sorts of changes need to be made in the social order to make it a decent place to live in (for things besides the marijuana laws).
216. Sounds have visual images or colors associated with them, synchronized with them.
217. I get much more involved in ordinary tasks than when I'm straight: they're completely absorbing.
218. With my eyes closed, my inner visions and fantasies become extremely real, as real as nighttime dreams.
219. I suddenly realize that nothing has been happening for a long time; my mind has been blank and nothing was going on.
220. I move up to higher levels of consciousness in jumps, sudden increases, rather than smoothly.
What important or characteristic things happen to you when you're stoned that haven't been described above? Could you describe each one and rate it in the same way below? Use the back of this sheet if needed.
221. ...
Frequency? Never Rarely Sometimes Very Often Usually How Stoned? Just Fairly Strongly Very Strongly Maximum LSD
222... 223...
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