12-Step Member Survey

Consent to be a Research Participant

 
You will need to read and consent to the conditions of the study before being able to proceed to complete this study.

If you have any questions about this consent form, please contact Amy Wytiaz, M.S. via email at the following address: awytiaz@paloaltou.edu.
Consent to be a Research Participant

Members’ Experiences in Twelve-Step Fellowships

You will need to read and consent to the conditions of the study before being able to participate.

If you have any questions about this consent form, please contact Amy Wytiaz, M.S. via email at the following address: awytiaz@paloaltou.edu.

A. PURPOSE AND BACKGROUND
Under the supervision of Louis Moffett, Ph.D., Amy Wytiaz, a doctoral student at Palo Alto University, is conducting a study to learn more about individuals who have participated in twelve-step programs and factors which may be associated with participating in such programs.

You are being asked to participate in this study because you have personal experiences with involvement in twelve-step program(s), such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). The purpose of this study is to gather information about individuals involved in twelve-step programs, including the following: basic demographic information (e.g. age, gender, and ethnicity); relationship styles; relationships with other twelve-step members; current and past substance use; and twelve-step involvement. The aim of gathering this data will be to provide treatment professionals with information to 1) provide professionals with a more comprehensive understanding of twelve-step members’ experiences, and 2) better guide individuals who have abused substances to recovery resources.

B. PROCEDURES
If you agree to participate in this study, the following will happen.

1. You will be provided with a SurveyMonkey.com link to complete a web-based survey.
2. You will be asked to complete several questionnaires regarding basic demographic information (e.g. age, gender, and ethnicity); general relationship styles; relationships with other twelve-step members; current and past substance use (e.g. “drug of choice” and length of time clean/sober); confidence in remaining clean/sober; and twelve-step involvement.
3. Participation in the study will take a total of about 25-40 minutes and will be completed entirely online in a one-time session. You may complete this study at home or wherever you have Internet access.
4. Once you have completed the study, you may (or may not) elect to enter into a lottery drawing for an Amazon e-gift card. If you elect to enter the lottery, you will be provided with another SurveyMonkey.com link where you will be asked to provide contact information in order to receive the gift card.

C. RISKS/DISCOMFORTS
1. While there are no foreseeable risks to your physical or psychological health associated with this study, some individuals may experience discomfort when answering questions of a personal nature. Answering the questions may lead you to reflect on issues related to your substance abuse, relationships, or twelve-step experiences. You may elect to withdraw from the study at any time should you experience distress. A list of national resources is provided on the next page for your convenience should you wish to seek services after completing this study.

2. Confidentiality: Participation in research may involve a loss of privacy, but
information about you will be handled as confidentially as possible. During this study, you will not be asked to provide information which could be used to identify you.


Informed Consent (continued)

After completing the study, if you elect to participate in the optional lottery drawing for an Amazon e-gift card, you will be required to provide a working email address and a pseudonym (any first name other than your actual first name) in order for the e-gift card to be delivered. It is recommended that the email address provided does not contain personal information to reduce the likelihood of breaches in confidentiality. This information will be gathered through a separate SurveyMonkey.com link and will not be linked to your study responses in any way, thus your identity will not be matched to your responses.

Only the primary investigator will have access to your email address and pseudonym and this information will be saved into a document on a password protected computer. Because the surveys are administered through a third party (SurveyMonkey), your confidentiality will only be protected to the degree that technology permits. The use of a pseudonym, rather than an actual first name, as well as an email address that does not contain your personal information is highly suggested to reduce the risk of breached confidentiality. The primary investigator will not contact you after the study, other than to send an e-gift card if you are selected through the lottery.

Aside from the above mentioned risk of using web-based survey links, no personal information shall be disclosed to anyone without your permission or unless required by law (i.e., court-ordered release of information, duty to protect against imminent danger to self or others, and suspicion of child, dependent, or elder abuse). Information obtained in this research project may be published in journals or presented at meetings, but no identifying information shall be revealed.

D. BENEFITS
Individuals participating in this study are not expected to receive any direct physical or psychological benefits for their participation. However, answering survey questions may lead you to reflect on your individual experiences and may be valuable toward understanding your substance use, relationships, and twelve-step programs.

In addition, study results have the potential to benefit twelve-step members and individuals who have abused substances, at large, as well as individuals receiving psychological treatment who may benefit from referrals to twelve-step programs. Results may also enhance clinicians’ understanding of twelve-step member’s experiences and their ability to provide effective treatment interventions.

E. ALTERNATIVES
There are no alternatives to this study.

F. PAYMENT
You will not be paid for participating in this study. However, you will have the opportunity to enter into a lottery drawing for an Amazon e-gift card. The gift cards range in amount from $25- $50 and may be used for purchases at Amazon.com.

G. QUESTIONS
This study has been explained to you in the sections above. If you have any other questions, you may contact Amy Wytiaz by email (awytiaz@paloaltou.edu).

Questions about your rights as a participant in this study may be presented to the Institutional Review Board Chair by mail at IRB, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304 or by phone at 650-433-3827.

H. CONSENT
Please print copies of the consent form for your records at the time of the study. Once you have completed the study, if you wish to receive a copy of this consent form, you may obtain one by sending an email request to awytiaz@paloaltou.edu.

PARTICIPATION IN RESEARCH IS VOLUNTARY. You have the right to decline to participate or to withdraw at any point in this study without any consequences.

Clicking on the “Proceed” button at the bottom of the Informed Consent page indicates that you have read and understood this consent form, and consent to participate in this study.

If you wish to participate, please click the “Proceed” button and continue on to the study.
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1. I have read the Informed Consent agreement and agree to participate in the study.
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