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RESEARCH PARTICIPANT INFORMATION FORM
12-Step Approach to Recovery
Heather L. Servaty-Seib, Ph.D.
Purdue University
Educational Studies
Purpose of Research
The purpose of this study is to examine various aspects of the 12-step approach to recovery. The study is designed to learn more about what aspects of AA and NA help promote better recovery. The information you provide will be invaluable in providing mental health professionals with a better understanding of the 12-step approach to recovery, as well as improvement in the delivery of and continuity of care for individuals with substance abuse problems.
Specific Procedures
This online survey contains a demographic sheet, questions about your substance use, recovery efforts, participation in AA/NA, as well as a variety of other questions pertinent to the study. Please consider taking part in the study by completing the questionnaire and clicking on submit when you are completed.
Duration of Participation
The completion of the survey will take you approximately 20 minutes.
Risks
The risks involved in participation are no more than would be encountered in everyday life.
Benefits
There are no obvious personal benefits from participating in this study.
Conditions of Participation
Individuals must be at least 18 years of age to participate.
Compensation
If you choose to participate in the study, you will have the opportunity to voluntarily participate in a drawing for a gift certificate of $100 to either Target or Wal-Mart. After completing or discontinuing participation in the study, you will be redirected to another website where you will submit your e-mail address, without your name or any other identifying information; there will be no way to connect your individual responses on the survey website to the e-mail address you enter for the drawing. One e-mail address will be drawn form the pool of those who wish to be entered into the drawing. If your e-mail address is drawn, you will receive a $100 gift certificate to your choice of either Target or Walmart. The odds of the drawing will be no more than 1 out of 500. If your e-mail address is drawn from the pool, you will be contacted via e-mail and asked to indicate which type of gift certificate you prefer. Your participation in this incentive is voluntary. You do not have to provide your e-mail address if you choose not to participate in the drawing.
Confidentiality
The privacy and confidentiality of your responses will be protected through multiple methods. You are not asked to provide your name or any identifying material on the survey instrument other than general background information. Information connected to the IP address of the computer you use will not be collected. While a complete guarantee of privacy cannot be promised when completing a form on the Internet, there will be no greater risk than would otherwise be expected when using the internet. Participant responses will be evaluated and presented collectively (i.e., individual responses will not be evaluated or presented). The aggregated data may be provided to Purdue University, presented at a conference, submitted to a journal for publication, or used in a dissertation for purposes of providing an improved understanding of the 12-step approach to recovery as outlined above. The data will be kept indefinitely and will only be used for the purposes indicated above. Only the researchers can access the confidential website containing participant’s responses. The project's research records may be reviewed by departments at Purdue University responsible for regulatory and research oversight. Voluntary Nature of Participation You do not have to participate in this research project. If you agree to participate, you can withdraw your participation at any time without penalty.
Contact Information
If you have any questions about this research project, you can contact Heather L. Servaty-Seib at (765) 494-0837 or Cathy Streifel at (765) 430-6192 or cathystrf@aol.com. If you have concerns about the treatment of research participants, you can contact the Institutional Review Board at Purdue University, Ernest C. Young Hall, Room 1032, 155 S. Grant St., West Lafayette, IN 47907-2114. The phone number for the Board is (765) 494-5942. The email address is irb@purdue.edu.
PLEASE PRINT COPY OF THIS FORM FOR YOUR RECORDS
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