Western Illinois University

Department of Psychology

Informed Consent for “Emotion and Substance Use” Study



The purpose of this study is to learn about emotions and drug use. The study will last 15 minutes or less and will involve answering questions about your experiences with emotions, motives for substance use, and the use of alcohol and marijuana. You will also be asked some basic demographic information. You must be at least 18 years of age to participate in this study.



Because you will be asked to respond to questions concerning legal and illegal substance use behaviors that are somewhat personal, you may experience some discomfort. Overall the risks are expected to be no greater than those found in normal daily activities. Participation in this study is voluntary, and refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled. You may discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled. Any questions that seem too personal or cause discomfort may be skipped.



Data collected will be securely stored in Waggoner Hall. No personally identifying information will be recorded. All records obtained are confidential, which means that only the researchers have access to these files.



In addition, you will be directed to a separate survey at the end of the study, in which you may provide an email address for a chance to win a $25 Wal-mart gift card. If you choose to provide an email address, it will not be linked to your survey responses in any way and will be used solely for the purpose of the raffle.



At the end of the study you will learn more information regarding the nature of the study. Counseling information will also be provided at the end of the survey.



If you have any questions regarding your participation or this study, you can contact the researchers Heather Lucke at HR-Lucke@wiu.edu or Dr. Eugene Mathes at EW-Mathes@wiu.edu (309-208-1593).



This study has been approved by the IRB. However, if you have questions about your rights as a research participant, please contact the Western Illinois University Institutional Review Board (IRB) at (309) 298-1191, or IRB-Adminsitrator@wiu.edu.







By clicking NEXT, you indicate you have read and understand this explanation of the study and agree to participate.