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r4KJJLeGWdyuictoQtaDA7eAwz5ySnSqbihqkcu2TWv6KXzhDwXRAPIXXE7xGG6wLeqU

Eligibility Survey

Date completed

Sex differences in brain function during early abstinence in alcohol use disorders

IRB# 0279-21-FB

What is the purpose? The purpose of the study is to learn about the brain during recovery from alcohol use disorders. We also want to see whether there are brain differences between men and women during recovery.

What does participation look like? The study will require two study visits, each of which will take about 3 hours of your time. A drug urine screening and breathalyzer will be completed at each visit.

Visit 1: The first study visit occurs at the Munroe-Meyer Institute at the University of Nebraska Medical Center. You will fill out a set of questionnaires and complete a clinical interview. We want to learn about your mental health history, including any anxiety, depression, drug and alcohol use, etc.

Visit 2: The second study visit will take place at Clarkson Tower at UNMC's main campus and involve an MRI scan. You will complete a task that will help us look at how your brain. The task involves looking at different pictures, some of which may be distressing. We will draw a vial of blood and collect saliva samples.

You may receive compensation for participation in each of the study visits.

This study is being conducted solely for research purposes and your participation is strictly voluntary. If you are interested in taking part, we will ask you to sign a form to indicate that you consent to taking part in the study. If you consent to participate, you may withdraw from the study at any time.

You may be eligible for this study if you:
1. Are between 22-40 years old
2. Have no history of alcohol problems OR
Have a history of alcohol problems AND have been sober for 30-180 days

You may not be eligible for this study if you:
1. Cannot complete an MRI due to metal in your body or claustrophobia
2. Have a neurological disorder or significant medical illness
3. Are pregnant or in menopause

If you are interested in participating in this study, please answer the following screening questions. The form will take less than five minutes to complete. Thank you!

If you have questions, please email mmialcoholstudy@unmc.edu or call (402) 836-9953

Would you like to continue to the eligibility questions?

* must provide value

Yes

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How did you hear about the study?

* must provide value

Are you between the ages of 22-40?

Yes

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Are you pregnant or in menopause?

Yes

Not sure

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Do you have metal in your body, including but not limited to braces, an irremovable body piercing or jewelry, dental plate, metal fragment, surgical staple or clip, joint replacement, pacemaker, cochlear implant, or shunt?

Yes

Not sure

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Do you currently weigh more than 300 pounds or have a history of claustrophobia?

Yes

Not sure

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Are any of the following true for you:
I have had a head injury or a concussion that knocked me out for more than 10 minutes.
I have a neurological or central nervous system illness (such as stroke, brain tumor, multiple sclerosis, or epilepsy).
I have a significant medical illness (such as cancer or HIV).
I have been diagnosed with or treated for schizophrenia or another psychotic disorder.

None of these are true for me

At least one of these is true for me

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Within the past 6 weeks (including now) have you taken medications that might affect your brain function? This would include medications that have been prescribed to you and also other medications or drugs. Some examples are medications for alcohol craving (like naltrexone), stimulants for ADHD, medications for depression or anxiety (like SSRIs or SNRIs), opioids, marijuana, methamphetamine or cocaine.

Yes

Not sure

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Have you ever excessively used, abused, or been dependent on alcohol or have you been diagnosed with alcoholism or an alcohol use disorder?

Yes

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Have you had at least one alcoholic drink in the last year?

Yes

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Have you ever been diagnosed with or treated (medications, therapy, etc.) for any mental health issues, including anxiety, depression, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, ADHD, bipolar disorder, or a substance use disorder?

Yes

Not sure

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Are you currently sober/not using alcohol?

Yes

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Have you been sober for longer than 2 weeks and less than 6 months?

Yes

Not sure

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.