University of California, Los Angeles
CONSENT TO PARTICIPATE IN RESEARCH
Expectations of 'Recovery' - Changes associated with seeking
and entering treatment through an online service-matching system
You are asked to participate in a research study conducted by Adi Jaffe, Ph.D. and associates from the Integrated Substance Abuse Programs at the University of California, Los Angeles. You were selected as a possible participant in this study because of your indication that you are seeking treatment for alcohol or drug dependence or another addictive disorder. Your participation in this research study is voluntary. After reading below, please choose whether to continue on to the study's screening portion or to exit from the study by pressing the appropriate button.
Why is this study being done?
We are conducting this study in order to test whether people's ideas regarding recovery
from addiction changes as they move from treatment seeking to exploring treatment
options, contacting, and enrolling in treatment. We are also testing the usefulness of using
an automated system to help people who are looking for treatment find appropriate
providers.
What will happen if I take part in this research study?
If you volunteer to participate in this study, the researcher will ask you to do the following:
You will be asked to fill out an online assessment today and in one week, one month, and
six months from today and will be compensated for each of these assessments.
You will be asked to provide information about your drug and alcohol use history,
employment, treatment history, and about your thoughts and expectations regarding
addiction treatment.
How long will I be in the research study?
Participation in the study will take a total of about one hour split during four sessions over a period of six months
Are there any potential risks or discomforts that I can expect from this study?
Some of the questions you will be asked will require you to give information that could potentially be uncomfortable to give. However, we have tried to minimize any such discomfort and you may select to take the surveys in as private an environment as you would like to minimize such effects further.
Are there any potential benefits if I participate?
There is no immediate benefit associated with participating in this study. However, the results of the research may help future treatment seekers by improving our ability to match them with services and also by informing future programs that can target specific recovery perceptions that may be found to delay treatment entry.
Will I receive any payment if I participate in this study?
You will receive gift certificates in the amount of $15, $10, $25, and $30 for your first, second, third, and final assessments respectively.
Will information about me and my participation be kept confidential?
Any information that is obtained in connection with this study and that can identify you will remain confidential. It will be disclosed only with your permission or as required by law. Confidentiality will be maintained by means of separating any identifying information from the data and securing the connecting file with the Principal investigator named above.
Withdrawal of participation by the investigator
We have applied for a Certificate of Confidentiality from the National Institutes of Health.
With this Certificate, the researcher cannot be forced to disclose information that may
identify you, even by a court subpoena, in any federal, state, or local civil, criminal,
administrative, legislative, or other proceedings. The researchers will use the Certificate to
resist any demands for information that would identify you, except as explained below.
The Certificate cannot be used to resist a demand for information from personnel of the
United States Government that is used for auditing or evaluation of Federally-funded
projects or for information that must be disclosed in order to meet the requirements of the
federal Food and Drug Administration (FDA).
You should understand that a Certificate of Confidentiality does not prevent you or a
member of your family from voluntarily releasing information about yourself or your
involvement in this research. If an insurer, employer, or other person obtains your written
consent to receive research information, then the researchers may not use the Certificate
to withhold that information.
The Certificate of Confidentiality does not prevent the researchers from disclosing
voluntarily, without your consent, information you provide on current child/elder abuse that
is given to the researchers, or if there are threats to harm yourself or others, the
researchers will report this to the authorities.
Confidentiality will be maintained by means of separating any identifying information from
the data and securing the connecting file with the Principal investigator named above.
What are my rights if I take part in this study?
You may withdraw your consent at any time and discontinue participation without penalty or loss of benefits to which you were otherwise entitled.
You can choose whether or not you want to be in this study. If you volunteer to be in this study, you may leave the study at any time without consequences of any kind. You are not waiving any of your legal rights if you choose to be in this research study. You may refuse to answer any questions that you do not want to answer and still remain in the study.
Future use of data
Please check the appropriate box below and initial:
Financial disclosure
Dr. Jaffe, the principal investigator in the study, is also the owner of California Treatment Services, LLC., the company that owns the website www.allaboutaddiction.com. Your participation in the study is not expected to affect any income from the website and all work resulting from the study will include a disclosure as to Dr. Jaffe's financial interests in California Treatment Services, LLC.
Who can answer questions I might have about this study?
In the event of a research related injury, please immediately contact one of the
researchers listed below. If you have any questions, comments or concerns about the
research, you can talk to the one of the researchers. Please contact Dr. Adi Jaffe at (310)
267-5289 or by email at adi@ucla.edu..
If you wish to ask questions about your rights as a research participant or if you wish to
voice any problems or concerns you may have about the study to someone other than the
researchers, please call the Office of the Human Research Protection Program at (310)
825-7122 or write to Office of the Human Research Protection Program, UCLA, 11000
Kinross Avenue, Suite 102, Box 951694, Los Angeles, CA 90095-1694.
By pressing the "continue" button below you are letting the researchers know that your participation is voluntary and that you understand the information above.