Journaling and Addiction Recovery: Piloting "Positive Recovery Journaling"
Phase: NA
Conditions: Addiction
Sponsor: University of Minnesota

PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
 
 
 
PROTOCOL COVER PAGE 
Protocol Title
Journaling and Addic.on Recovery
Principal 
Inves9gator/Faculty 
Advisor
Name: Amy R. Krentzman
Department: Social Work
Telephone Number: 612-625-2312
Email Address: akrentzm@umn.edu
Student Inves9gator
Name: N/A
Current Academic Status (Student, Fellow, Resident): N/A 
 
Department: N/A
Telephone Number: N/A
Ins.tu.onal Email Address: N/A
Scien9ﬁc 
Assessment
Not required, Minimal Risk Study
Version Number/
Date:
Version: 23 Date: 13 April 2021 
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
REVISION HISTORY 
Revision #
Version Date
Summary of Changes
Consent Change?
2
10.11.18
Miscellaneous small changes 
required as part of pre-review 
process
Yes
3
11.12.18
7 changes itemized in 10/30/18 
le[er from the IRB.
Yes
4
12.20.18
Numerous revisions to screening 
consent, consent form, ﬂyer, and 
protocol that adapt the study to the 
treatment center se_ng and 
ﬁnalize the details of study 
l
Yes
5
2.3.19
Revisions to the protocol that 
clarify research assistant du.es and 
content of treatment group 
No
6
2.12.19
Numerous minor revisions to 
screening consent, regular consent, 
screening check sheet, and 
l
Yes
7
2.26.19
Minor revisions to informed 
consent document, HIPAA 
Authoriza.on form, and a footnote 
describing that in addi.on to 
coun.ng the journal entries 
uploaded to Qualtrics we will 
addi.onally manually count the 
journal entries in the paper journal, 
b
Yes
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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3.18.19
Now we are ready to recruit the 
second set of 5 par.cipants. 
Therefore, we submit changes to 
various study documents. We will 
oﬀer the group sessions over three 
weeks instead of over four weeks. 
Minor changes to informed consent 
and screening consent documents. 
Minor changes to protocol. Now 
that we have ﬁnished the ﬁrst 8-
session group, we upload a detailed 
list of contents for all 8 sessions and 
submit the handouts we used 
during group. During screening we 
will have par.cipants sign a release 
of informa.on with the host 
se_ng, so we can return their 
phone calls. We will also teach 
them a few iPad basics during 
screening, to spend more .me in 
group on the therapy and not on 
teaching the technology. We added 
three standardized measurement 
instruments and some single-item 
assessment instruments. We will 
revise the actual journal. Now, we 
include the content of handouts 
that we have used in group in the 
journal pages (see a[achments). 
Details are described herein.
Yes 
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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3.25.19
Responding to required 
modiﬁca.ons from the IRB. 
Regarding our use of a trauma 
assessment instrument at baseline: 
in this revision, we clarify that we 
use the ﬁrst item of the trauma 
instrument only to assess trauma 
exposure and not trauma 
symptoms, we ask this ques.on to 
enable us to describe the 
characteris.cs sample. NUWAY Inc. 
already screens all clients for 
trauma, but we will no.fy NUWAY 
Inc. if any par.cipant in the study 
seems to be having diﬃculty with 
study ac.vi.es because of trauma 
h
10
6.3.19
Protocol revised to include an 
electronic survey to be sent to the 
staﬀ of the host treatment center 
(“NUWAY Inc.”). The purpose of this 
staﬀ survey is 1) to gather 
informa.on about the 
implementa.on of the study 
logis.cs at NUWAY Inc. to op.mize 
logis.cs before we recruit for the 
third cohort and 2) to gather staﬀ 
perspec.ves of client experiences 
of study par.cipa.on.
No
11
6.20.19
Miscellaneous changes to protocol 
as we prepare to recruit for the 
third and ﬁnal cohort: changes to 
exit interview ques.ons; minor 
changes to protocol; minor changes 
to ques.onnaires. 
No
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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10.10.19
As the current phase of this study 
concludes and the next phase 
begins, there are several changes to 
the protocol: 
1. Changes in research staﬀ (Ms. 
Staab and Ms. Tillman are no longer 
on the project; Rebecca Donaldson 
has been added) 
2. Changes in funding source 
3. Change in research se_ng from 
Wayside to NUWAY (including a 
new le[er of agreement from 
NUWAY, a[ached) 
4. No longer a focus on rural 
popula.ons (although we will retain 
one ques.on in the exit interview 
about the interven.on’s applica.on 
in rural communi.es) 
5. Revisions to screening consent, 
now version 8 (informa.on about 
being on the wait list is retained 
here) 
6. Revisions to informed consent, 
now version 12 (informa.on about 
being on the wait list is deleted 
here, covered in #5, above) 
7. Journals to be distributed for 
informal feedback 
8. Keeping counselors informed of 
study par.cipant ac.vity 
9. New study will use a cer.ﬁcate of 
conﬁden.ality. 
10. Changes to screening check 
sheet, now version 5 
11. Miscellaneous small changes 
and correc.on of typos 
12. There will be no staﬀ survey at 
the new site, so staﬀ survey 
informa.on has been removed 
from protocol and from ethos 
a[ached documents 
iﬁ
id
Yes
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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11/18/19
1. Miscellaneous minor updates 
related to the host se_ng. 
2. The addi.on of a control group 
and the modiﬁca.on of study 
documents to reﬂect addi.on of a 
control group (informed consent 
documents, screening documents, 
study ﬂyer, ques.onnaires, etc.). 
3. Change of name of the study 
4. For this next phase, 
clinicaltrials.gov is not required, 
therefore, we remove that number 
from the ethos system and our 
informed consent documents 
5. Fix miscellaneous typos 
6. Minor modiﬁca.ons to HIPCO 
survey.
Yes
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Summary of Changes
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
14
5/1/20
Modiﬁca.ons to convert the study 
to online delivery so that it can 
proceed during safe prac.ces for 
social distancing during the covid19 
pandemic. Language for face-to-
face administra.on is retained in 
case social distancing laws are 
changed in .me, but the plan as of 
this wri.ng is to conduct this study 
remotely. This set of modiﬁca.ons 
also includes: updates and 
improvements to informed consent 
documents. Changes in research 
staﬃng.  Modiﬁca.ons to the text 
within the journals. Fixing typos. 
Addi.on of “quick start” journaling 
instruc.ons. Changing main study 
site collaborator. Addi.on of 
treatment site prescreening 
checklist, to be used by treatment 
staﬀ. Addi.on of email or text 
reminders to treatment and control 
groups. Use of REDCap to collect 
and organize study data including 
informa.on formerly collected on 
our screening check list, 
recruitment and enrollment and 
reten.on data, informed consent 
signatures, group a[endance, study 
par.cipa.on, exit interview, and 
follow up interview data. Changes 
to measurement instruments. We 
moved the detailed instruc.ons for 
the treatment and control groups 
out of the informed consent 
document into a separate 
instruc.ons document “instruc.ons 
for gold and maroon groups v2” 
and kept basic informa.on about 
the two groups in the informed 
consent document. We used the 
l
bi
Yes
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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7/22/20
Miscellaneous updates based on 
current round of recruitment, 
screening, and interven.on: control 
group will also get a copy of the 
quick start guide, research staﬀ 
might also conduct the pre-
screenings during recruitment 
phase, par.cipants will be 
encouraged to do their last journal 
entry (if applicable) and complete 
their Qualtrics ques.onnaire before 
the exit interview (instead of during 
the exit interview). Par.cipants will 
be encouraged to complete their 
Qualtrics ques.onnaire before the 
follow up interview. We will 
con.nue to send emails with survey 
links un.l the end date of study 
ac.vi.es, in case someone who has 
been inac.ve wishes to resume 
study ac.vi.es. Change of inclusion 
criteria to approximately 2 weeks of 
abs.nence. Minor edits to exactly 
what is covered in each group 
session. Change in our use of Zoom 
video recordings. We have revised 
exit interview and follow up 
ques.ons and also have used 
PowerPoint slides during 
interven.on groups that we have 
a[ached to this set of 
modiﬁca.ons. Our screening 
checklist has been slightly updated 
and administered via REDCap, so 
we include this update.
No
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PROTOCOL TITLE: Journaling and Addiction Recovery
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8/7/20
We will add two ques.ons that we 
will administer halfway through the 
journaling groups (on 
approximately group #4): “what is 
working for me in this journaling 
group is…” and “what is not 
working for me in this journaling 
group is…”
Yes but the 
informed consent 
changes are not 
related to this 
change men.oned 
on the les. The 
informed consent 
modiﬁca.ons 
eliminate 
redundancies to 
our previous 
version and make 
the electronic 
versions easier to 
sign for remote 
signatures.
17
8/25/20
We will now be recrui.ng from an 
addi.onal “branch” or site under 
the host-se_ng umbrella. The host 
se_ng is NUWAY. The current 
recruitment site is “3Rs.” We will 
now also be recrui.ng from 
“NUWAYIII.”
No
18
9/18/20
Minor changes to study ﬂyer. 
Addi.on of new “branch” or site 
under host se_ng (NUWAY) 
umbrella from which we will 
recruit. Updated “quick start guide.” 
Ability to send addi.onal journal to 
Maroon group par.cipants who 
request it at the 1 month follow up 
interview. Research staﬀ will create 
short video recorded group session 
“recaps” which will be useful for 
anyone who misses a group or 
wants to review content. The 
recaps have the same content as 
group sessions. Updates to exit 
interview scripts. Other minor 
d
No
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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10/25/20
Minor updates to informed consent 
documents (to ﬁx typos and add 
clarity), minor changes to exit 
interview scripts, submission of the 
text of and links to the short video-
recorded group session “recaps” 
(same content as the group 
sessions, made available to 
par.cipants as review or if they 
missed all or a part of a session). 
Updates and clariﬁca.on added to 
recruitment approach: in addi.on 
to our usual recruitment 
procedures, we will now make 
presenta.ons in client treatment 
groups (via zoom) and when able, 
will use the “journaling study 
recruitment presenta.on” 
PowerPoint slides to do so (which 
are based strongly on the content 
of our recruitment ﬂyers and are 
a[ached to this modiﬁca.on in 
ethos). Modiﬁca.on to 30 day 
follow up interview script: we will 
not invite the par.cipant to look at 
a calendar if that would be helpful, 
and to report to us the number of 
days they used any addic.ve 
substances (in addi.on to alcohol) 
because frequency of use is 
f l
Yes
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Summary of Changes
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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12/8/20
Minor edits to exit interview scripts, 
submission of updated slides used 
to teach the journaling groups, 
updated inventory of emails the 
study has sent to par.cipants, new 
combined exit and follow up 
interview script for treatment and 
control groups, protocol if a 
par.cipant is having technological 
diﬃcul.es that we cannot rec.fy 
during group sessions. We ﬁxed one 
typo in the protocol: par.cipants 
are eligible if they have been at the 
treatment center one week, not 
k
21
2/27/21
Minor typos corrected to protocol. 
Changes to recruitment strategy. 
Minor changes to exit interview 
scripts. Oﬀer of $40 in gis cards to 
counselors who agree to review, 
comment on, and propose edits to 
our dras treatment manual. All 
former par.cipants can request a 
new journal at any .me, and we 
will provide one as supplies last. 
Change in number of total 
par.cipants we hope to enroll, 
increased to 100 par.cipants.
Revision #
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Summary of Changes
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PROTOCOL TITLE: Journaling and Addiction Recovery
VERSION DATE: 13 April 2021
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3/11/21
Previous versions of this protocol 
stated that when the control group 
members ﬁnish the 1 month follow 
up check-in, they get a copy of the 
journal with wri[en instruc.ons for 
how to use it. We now want to 
addi.onally provide to control 
group members access to the study 
YouTube channel that features 
short videos that show how to use 
the journal. This is an addi.onal 
way for the control group to gain 
any beneﬁt from learning how to do 
the journaling that the treatment 
group receives. The videos have 
already been approved by the IRB 
and are currently in use by the 
treatment group. Also included in 
this IRB modiﬁca.on is the cover 
le[er we will mail to control group 
members explaining how to access 
the videos. This le[er is included as 
an a[achment to ethos. 
23
4/13/21
We are adding the University of 
Minnesota Box Secure Storage as a 
place where we share and store 
research ﬁles. When we collect data 
from the treatment provider, we 
will enter that informa.on in to 
No
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PROTOCOL TITLE: Journaling and Addiction Recovery
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Table of Contents 
1.0 
Objec.ves 
13 
2.0 
Background 
14 
3.0 
Study Endpoints/Events/Outcomes  
21 
4.0 
Study Interven.on(s)/Interac.on(s) 
21 
5.0 
Procedures Involved 
25 
6.0 
Data Banking 
46 
7.0 
Sharing of Results with Par.cipants 
47 
8.0 
Study Dura.on 
47 
9.0 
Study Popula.on 
48 
10.0 Vulnerable Popula.ons 
53 
11.0 Number of Par.cipants 
55 
12.0 Recruitment Methods 
55 
13.0 Withdrawal of Par.cipants 
58 
14.0 Risks to Par.cipants 
59 
15.0 Incomplete Disclosure or Decep.on 
62 
16.0 Poten.al Beneﬁts to Par.cipants 
62 
17.0 Data Management 
62 
18.0 Conﬁden.ality 
63 
19.0 Provisions to Monitor the Data to Ensure the Safety of Par.cipants 
64 
20.0 Provisions to Protect the Privacy Interests of Par.cipants 
66 
21.0 Compensa.on for Research-Related Injury 
67 
22.0 Consent Process 
67 
23.0 Se_ng 
68 
24.0 Mul.-Site Research 
69 
25.0 Resources Available 
69 
26.0 References 
71 
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ABBREVIATIONS/DEFINITIONS 
●
12-step programs = Community-based mutual-aid groups (such as Alcoholics 
Anonymous) comprised of individuals in recovery from a SUD and/or AUD 
that follow the 12 suggested steps of recovery. 
●
AA = Alcoholics Anonymous 
●
AUD = Alcohol Use Disorder 
●
In recovery = Maintaining abs.nence from addic.ve substances in order to 
address an AUD and/or SUD and place the AUD and/or SUD into remission.  
●
PPJ = “Posi.ve Peer Journaling”  
●
SMART goals = Goals that are Speciﬁc, Measurable, Achievable, Realis.c, and 
Timely. 
●
Sponsor = A member of a 12-step program who osen has more experience 
with recovery than another member who is selected by the less experienced 
member to serve as that person’s guide and to take a special interest and 
spend addi.onal .me with that member.  
●
SUD = Substance Use Disorder 
●
TGT = The gra.tude prac.ce called the “Three Good Things” exercise. 
●
WFO = The daily prac.ce where good wishes for others are listed. 
●
NUWAY=NUWAY, Inc., the host se_ng for the study. 
●
COVID19 = coronavirus pandemic/pandemic of coronavirus disease 2019. 
●
Zoom = Video teleconferencing service. 
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PROTOCOL TITLE: Journaling and Addiction Recovery
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1.
Objec9ves 
Purpose: Ci.zens across Minnesota suﬀer from substance use disorders and 
their consequences. Nearly 9% of Minnesotans met diagnos.c criteria for a 
substance use disorder (SUD) in 2010.1 Nega.ve consequences from 
substance use disorders suﬀered by Minnesotans have included death, 
arrest, incarcera.on, homicide, and suicide.2 The economic cost of alcohol 
use in the State was es.mated at $5.06 billion, or $975 per taxpayer, in 
2007.3 In this study we pilot test an interven.on we developed (called 
Posi.ve Peer Journaling, “PPJ”). All aspects of PPJ are described in detail in 
this protocol (speciﬁcally in sec.on 4.1, below). However, in order to clarify 
the sec.ons of this protocol that precede 4.1, a brief descrip.on of PPJ is 
provided here. 
Brief descrip9on of PPJ. Many spiritual and religious tradi.ons involve the 
prac.ce of moral inventory or moral self-examinina.on.4 These prac.ces 
involve conduc.ng a review of the day, spirituality, gra.tude, and striving 
for self-knowledge and self-improvement.4 The 10th step of Alcoholics 
Anonymous (AA) recommends that members conduct such a daily 
inventory.5 While this prac.ce may beneﬁt AA members, not everyone 
seeking addic.on recovery joins AA. Even for those who do, it can take .me 
to reach step 10 and begin deriving beneﬁts from it.  
We developed PPJ as a simple 10-minute daily prac.ce which reviews the 
past 24 hours on the les hand side of an open-page spread and plans the 
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upcoming 24 hours on the right hand side of the open-page spread of any 
standard journal.  
Two primary sources inspired PPJ. The ﬁrst is AA’s 10th step which 
recommends a regular “personal inventory” where the day is reviewed and 
what went well and what went poorly is iden.ﬁed and acknowledged.5 The 
second source of inspira.on for PPJ is the daily ac.on plan recommended in 
some 12-step programs where the upcoming day is planned with health 
and balance in mind, including ac.vi.es related to “recovery, recrea.on, 
and rela.onships in addi.on to work….”6 The AA 10th step prac.ced on the 
les hand page and the ac.on plan prac.ced on the right hand page 
together aﬃrm the value of each sober day and strengthen the odds of 
learning from the day’s events and planning a successful, balanced, and 
healthy upcoming 24 hours, which should strengthen quality of life in 
recovery.  
While each element of PPJ is explained in detail in this protocol (in sec.on 
4.1), we provide a visual snapshot of what a completed daily PPJ entry 
might look like in Figure 1 below. 
 
Figure 1. Posi9ve Peer Journaling (PPJ) Example 
Objec9ves. The main objec.ve of this study is to pilot test the PPJ 
interven.on and to examine the feasibility, acceptability, and logis.cs of 
treatment delivery.  
A second objec.ve is to observe whether PPJ is associated with 
improvement in hypothesized outcomes. The primary outcomes we will 
examine are enhanced treatment reten.on and reduced recurrence of 
substance use. We will also explore the associa.on between the 
interven.on and a set of hypothesized mediators of the eﬀect of the 
interven.on on outcomes, e.g., sa.sfac.on with recovery and improved 
mood. A complete list of hypothesized mediators is outlined in the 
measures sec.on 5.2 of this protocol. While our sample sizes will limit 
quan.ta.ve analysis, we will also employ qualita.ve exit interviews as will 
be described below to meet these research objec.ves. 
2.
Background 
2.1. Signiﬁcance of Research Ques.on/Purpose: Many scholars in the addic.on 
ﬁeld have made the case that clients with alcohol use disorders (AUD) and 
substance use disorders (SUD) should be helped to build an abs.nent 
lifestyle that is posi.vely reinforcing and more appealing than ac.ve 
addic.on.7–10 Many current interven.ons focus, reasonably and necessarily, 
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on reducing pathology,11 i.e., iden.fying triggers, reducing cravings, 
managing thoughts about alcohol, and coping with relapse.12 Pathology-
based treatments by themselves miss an opportunity to aid clients in 
building a posi.vely reinforcing life in recovery that will make the hard work 
of abs.nence worth the eﬀort.  
PPJ is designed to support the construc.on of a posi.ve, aﬃrming sober 
lifestyle. PPJ emphasizes expressing gra.tude and savoring what is posi.ve 
about sober life and making plans to support recovery based on each 
person’s prized values. If sa.sfac.on with recovery is increased, risk of 
relapse should decrease.  
2.2. Preliminary Data: Relevant Study #1. We conducted a qualita.ve study in 
which we gathered opinions of PPJ from 33 individuals residing in rural 
southeast Minnesota who have knowledge of SUD and AUD treatment and 
recovery. The sample was comprised of 61% people in recovery, 15% 
treatment providers, and 24% treatment providers in recovery. We 
conducted in-depth semi-structured interviews with par.cipants to 
ascertain their perspec.ves of PPJ. PPJ was presented and prac.ced one 
.me by par.cipants. We asked, “What are your observa.ons and thoughts 
about this journaling prac.ce?” “How can this prac.ce be helpful to 
individuals in recovery, if at all?” and “What might be a downside to this 
prac.ce, if any?” Interviews were audio recorded, transcribed, and 
analyzed for themes.13  
Overall, PPJ was perceived to be feasible and acceptable. The majority 
(79%) stated the prac.ce was feasible, e.g., “nothing too diﬃcult,” “faster 
than I thought it would be,” and “a really easy way to journal.” The majority 
(82%) oﬀered favorable impressions, e.g., “This is just a marvelous piece” 
and “I love it.” A quarter (27%) ini.ally had objec.ons to “journaling” but 
liked the prac.ce aser thorough introduc.on where they learned that PPJ 
involves bullet-pointed lists and not lengthy wri[en narra.ves. One 
par.cipant said: “That’s my kind of journaling. Just a phrase.” A ﬁsh (21%) 
were ready to get started with the prac.ce right away, e.g., “I’m so 
pumped, I’m going to buy a notebook aser this.” A ﬁsh (18%) expressed 
more moderate posi.ve inten.ons, e.g., “I should show this [to the sober 
house manager],” “I could see using this [for my treatment group],” and “I 
can talk to my sponsor…and see how we could put it in play.”  
Par.cipants stated that the prac.ce would aid recovery by increasing 
awareness of “what is,” e.g., it might aid becoming “more aware of 
themselves, and more aware of what’s going on in their life day to day.” The 
prac.ce would help them to focus their a[en.on on both the posi.ve and 
the nega.ve in a day of recovery, which was iden.ﬁed as helpful. Tracking 
the posi.ve would draw a[en.on to what is going well and help give one’s 
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self credit for things going right. It would increase awareness of posi.ve 
changes and provide an opportunity to express gra.tude. Tracking the 
nega.ve would help iden.fy issues that need a[en.on, put nega.ve things 
into perspec.ve, and inspire improvement. 
There were two excep.ons where people interviewed were hesitant about 
PPJ and in the current study we will take steps to address both of these 
concerns.  
First, people had concerns about a prac.ce that involved wri.ng. Some felt 
wri.ng was beneﬁcial, e.g., “get it out of your head” and “write it down, 
you’ve released it.” Some stated they felt they were not good at “wri.ng 
and all that kind of stuﬀ.” Others said they had “a hard .me concentra.ng.” 
A prac..oner recognized that clients osen have low levels of educa.on, 
sta.ng, “some of my clients only made it to 3rd grade so they get 
embarrassed to write stuﬀ.” To address this concern, we will explain that 
the prac.ce involves short bullet-pointed lists and not long pages of 
wri.ng. We will explain that grammar and spelling are not relevant for this 
prac.ce. We will explain that while the researchers will review a snapshot 
of a daily entry in the course of research ac.vi.es, and par.cipants will be 
invited to verbally share aspects of their entries, no other person will be 
shown their entries and no one will cri.que them. 
Second, some par.cipants of our pilot study expressed concern about 
ac.vity scheduling and planning. Many had posi.ve things to say about 
planning, e.g., it would help them to priori.ze tasks and it would provide 
reminders of important tasks. However, for others, planning might 
engender burdensome thoughts, e.g., “I hate remembering what I have to 
do in my home” or could cause feelings of disappointment, “my fear would 
be, I’d start it and then wouldn’t follow through… it would feed into my 
nega.ve thoughts.” To address this concern, we will invite par.cipants ﬁrst 
to iden.fy sober aspects of life that align with their values, and then 
iden.fy tasks that ﬂow from these values, as is recommended in the 
behavioral ac.va.on therapy LETS ACT.14–16 To build conﬁdence and 
success, par.cipants would aim to achieve zero tasks per day (planning 
only) and then one task a day at ﬁrst. Also, par.cipants are encouraged to 
plan the smallest next step of a task, so it will be achievable and not 
overwhelming. 
Relevant Study #2. A component of the les side of the page in PPJ is the 
“Three Good Things” gra.tude exercise to aid the review of the past 24 
hours. PI Krentzman conducted a randomized controlled pilot test of the 
“Three Good Things” gra.tude interven.on among AUD pa.ents.17 In the 
study, adult AUD outpa.ents were randomized to a gra.tude interven.on 
or ac.ve control group. All who were assigned to the treatment group 
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completed the 14-day gra.tude interven.on. The majority (91%) of 
par.cipants completed the gra.tude interven.on each day and, on 
average, 91% of par.cipants completed all gra.tude interven.ons over 14 
days. The gra.tude group rated the exercise as highly sa.sfying, pleasant, 
helpful, and moderately easy (averages of 8, 8, 8, and 6, respec.vely, on a 
scale of 0 “not at all” to 10 “extremely”). In mul.-level models to detect 
change in the slope of aﬀect over the 14-day treatment, unac.vated 
posi.ve aﬀect increased and nega.ve aﬀect decreased. Qualita.ve results 
depicted that the exercise became easier over .me. On days when things 
did not go well for individuals, par.cipants found it harder to name three 
good things; however, they reported that with eﬀort they could do so and 
that the prac.ce helped disrupt nega.ve thoughts and feelings. Par.cipants 
found that the exercise aﬃrmed recovery. On day 14, the majority of 
par.cipants (82%) reported they would con.nue the prac.ce but at 14-
week follow-up, few had con.nued the prac.ce and only one con.nued 
wri[en recording. Improvements in mood were not sustained at 14-week 
follow-up, presumably because individuals did not con.nue with the 
prac.ce. To address this concern, we will take steps to improve teaching 
and learning of PPJ which we believe will foster success and 
encouragement. We will provide small group sessions that involve coaching 
and modeling to help people with all PPJ ac.vi.es including the “Three 
Good Things” ac.vity. The later stages of learning PPJ includes an exercise 
(“each one teach one”) where each par.cipant will teach PPJ to another 
person in recovery, to cement learning and improve success and 
conﬁdence. 
Relevant Study #3. PPJ Development Study (This is phase 1 of the current 
study). In this one-armed (no control group) study, we administered PPJ to 
15 women. While we are currently analyzing these data, we do have 
preliminary informa.on on the demographics of the sample and PPJ 
feasibility, acceptability, and impact.  
The women’s ages ranged from 25-59, average age was 37. Most (67%) 
were white and the rest were black or African American, Na.ve American 
or Alaskan Na.ve, Asian or Paciﬁc Islander, and mul.racial. They had an 
average of 14 years of educa.on. Three quarters of the sample earned less 
than $15,000 last year. They had an average of 2 children. Most (70%) were 
involved in a legal case and most (90%) had a history of trauma. 
Roughly half (47%) had been addicted to amphetamines, one quarter (27%) 
to alcohol. A ﬁsh had been addicted to opiates and 7% to cannabis. Length 
of sobriety at baseline was 48 days (SD=32 days). The women had had 6 
previous treatment episodes (SD=3). On a 0-10 point scale with high 
numbers indica.ng high levels, the women had high commitment to 
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sobriety (10, SD=1), moderate happiness with recovery (7, SD=2), and 
moderate conﬁdence in their ability to remain sober (6, SD=2). On a scale 
that could range from 5-35, their average sa.sfac.on with life was 15 
(SD=6). Craving for drugs or alcohol was moderate on a 0-10 point scale: 5 
(SD=3). 
This study provided preliminary evidence for acceptability and feasibility of 
PPJ. On a scale of 0-10, with 10 represen.ng high levels, par.cipants gave 
PPJ high ra.ngs for being easy (8.6), sa.sfying (8.0), pleasant (7.9), and 
helpful (8.0) and low ra.ngs for being diﬃcult (1.6).  
In the sample overall, there were signiﬁcant increases in sa.sfac.on with 
life, happiness with recovery, and conﬁdence in the ability to remain 
abs.nent. Commitment to sobriety did not increase perhaps because 
baseline average levels were at the top of the scale (9.5/10 points).  
In the qualita.ve data, par.cipants emphasized two main beneﬁts from 
PPJ: 1) PPJ helped them to realize that more good things than bad things 
happened in a day and 2) PPJ’s right-hand side served as a simple planner 
which reminded the par.cipants to do things that were important and 
meaningful to them. When they were reminded in this way, the par.cipants 
acted to accomplish a wide range of recovery-suppor.ve behaviors. 
The majority (73.3%) were discharged from the treatment host se_ng on 
good terms (with staﬀ approval) and 73.3% did not use substances on or 
aser the onset of PPJ therapy (one person used substances aser intake but 
not again during treatment). Two thirds (66.7%) did not use substances and 
les on good terms. One used substances and les on good terms. One did 
not use substances but les against staﬀ advice. Three used substances and 
les at staﬀ request. Our preliminary work has demonstrated 1) high rates of 
treatment reten.on for the “Three Good Things” study, 2) high 
acceptability and feasibility among AUD pa.ents for the “Three Good 
Things” exercise and among SUD pa.ents for PPJ, 3) signiﬁcant impact of 
the “Three Good Things” exercise on improvement in mood, and 4) 
revela.on of important considera.ons to address as we implement the 
interven.on moving forward. 
2.3. Exis.ng Literature: PPJ is a novel interven.on, but it draws most strongly 
from two bodies of research: 1) the research on gra.tude and its 
rela.onship to addic.on recovery (PPJ includes two gra.tude exercises on 
the les hand side of the page) and 2) the research on ac.vity scheduling 
and behavioral ac.va.on to support addic.on recovery (featured on PPJ’s 
right hand side page). 
Research on Gra9tude and Addic9on Recovery. Anecdotally we know that 
gra.tude is a strong component of addic.on recovery in 12-step programs 
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such as Alcoholics Anonymous. It is a common theme in AA mee.ngs18 and 
is a prevalent theme in AA literature.19 Recent empirical inves.ga.ons into 
this phenomenon suggests that trait gra.tude correlates posi.vely with 
recovery suppor.ve factors and nega.vely with factors that might 
challenge recovery.18 Research also suggests that gra.tude prac.ces are 
associated with improvement in mood, which should make recovery more 
posi.vely reinforcing.17 Suppor.ng recovery and improving mood should 
reduce relapse risk. In the paragraphs that follow, this body of research is 
described in detail. 
In a cross sec.onal study of 105 men in treatment for substance use 
disorders while incarcerated, frequency of drug use in the 12 months 
before incarcera.on was nega.vely correlated with trait gra.tude during 
treatment.20 In the only study we are aware of that explored the role of 
gra.tude speciﬁcally as it occurs in 12-Step programs, LaBelle and 
Edelstein18 surveyed 184 members of Alcoholics Anonymous and Narco.cs 
Anonymous in a cross sec.onal study. The authors found that trait gra.tude 
was posi.vely associated with wellbeing outcomes (post-trauma.c growth 
and social support) and 12-step factors (12-step prac.ces and AA 
promises). Trait gra.tude was nega.vely associated with number of 
physical health symptoms.  
Three studies explored change in trait gra.tude before and aser SUD 
treatment. Charzyńska21 found that trait gra.tude increased among women 
but not men between baseline and treatment comple.on, ﬁve to seven 
weeks later. Krentzman22 found that trait gra.tude did not change between 
treatment entry and 6-month follow-up. Charzyńska and colleagues23 built 
on their earlier study21 by increasing the number of par.cipants from 112 
to 358 and using latent class growth analysis and three .me waves to form 
latent class trajectories of gra.tude from pre-treatment to 6-month follow-
up. They found four heterogeneous classes. Individuals with high gra.tude 
at baseline maintained high gra.tude, two classes of individuals with low 
gra.tude at baseline showed increases in gra.tude, and a class with 
moderate gra.tude at baseline showed decreases in gra.tude. These 
classes were diﬀerent by baseline educa.on, religiosity, and age, but not by 
gender. 
Krentzman22 found a signiﬁcant interac.on between current drinking status 
and trait gra.tude on future abs.nence. Trait gra.tude was posi.vely 
associated with abs.nence among those abs.nent at 6 months, and 
nega.vely associated with abs.nence among those drinking frequently at 6 
months. 
Studies of gra.tude as an interven.on to improve mood have been 
conducted among individuals with substance use concerns. An 8-week 
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posi.ve-psychology interven.on was constructed to include gra.tude and 
other interven.ons to boost posi.ve emo.on and suppor.ve behaviors and 
tested among adolescents with substance use problems. The interven.on 
showed increases in happiness, op.mism, and posi.ve aﬀect rela.ve to a 
comparison group.24 A 5-session posi.ve-aﬀect interven.on was conducted 
with men who were methamphetamine users and who had sex with men. 
The interven.on included gra.tude exercises as well as other strategies to 
induce posi.ve aﬀect such as no.cing posi.ve events, mindfulness, posi.ve 
reappraisal, strengths, and altruism. Individuals randomized to this 
treatment showed a trend toward increases in posi.ve aﬀect. Qualita.ve 
data indicated that par.cipants found the interven.on to support their 
recovery. However, the comparison condi.on showed signiﬁcant reduc.ons 
in nega.ve aﬀect, compared to the treatment group.25 A gra.tude 
interven.on, the “Three Good Things” exercise26 was piloted in a small 
sample of adults in treatment for alcohol use disorders. The gra.tude 
interven.on increased feelings of ease and calm and decreased nega.ve 
aﬀect.17 
Research on Ac9vity Scheduling and Behavioral Ac9va9on to Support 
Recovery. Behavioral ac.va.on therapy is another powerful strategy for 
making abs.nence more posi.vely reinforcing, and ac.vity scheduling is a 
key component of behavioral ac.va.on. Ac.vity planning comprises the 
right hand side of the page in PPJ. The Life Enhancement Treatment for 
Substance Use (LETS ACT) is behavioral ac.va.on treatment27,28 modiﬁed 
for individuals with substance use disorders. Three randomized controlled 
trials showed that compared to comparison groups, LETS ACT par.cipants 
demonstrated lower levels of depression15 and anxiety,15 greater enjoyment 
of ac.vi.es,15 higher ac.vity levels,16 decreased dropout from treatment,16 
and increased abs.nence at 3-, 6-, and 12-month follow-ups.14 This work is 
similar to what we are proposing herein, i.e., daily ac.vity scheduling that is 
aligned with an individual’s values for a sober life. We hypothesize that the 
beneﬁts of PPJ will approximate the similar beneﬁts found from LETS ACT 
therapy.  
Ra9onale for PPJ. Why combine daily life review (including gra9tude 
interven9ons) with planning for the future (ac9vity scheduling) in a daily 
exercise? Gra.tude interven.ons and ac.vity scheduling should reinforce 
and extend each other’s impact. A posi.ve correla.on between higher 
levels of gra.tude and greater behavioral ac.vity have been reported.29,30 
This associa.on may be causal: in previous research, gra.tude has been 
shown to improve aﬀect17,31 which has been shown to encourage more 
frequent and more diverse types of ac.vity.32 Therefore, gra.tude 
interven.on should encourage posi.ve, abs.nent behavior. Conversely, 
ac.vity scheduling will enhance gra.tude by guiding individuals to shape 
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their own posi.ve experiences rather than to passively no.ce them. 
Posi.ve behaviors will produce content to populate the next day’s gra.tude 
inventory.  
3.
The next phase of this study will add to the exis9ng knowledge base 
because we will collect more informa9on about PPJ’s feasibility, 
acceptability and impact with a larger sample size. Our 
development study included only women; this phase of the study 
will include women and men. We will also have a control group in 
this next phase of the study. We will also modify the protocol so we 
can conduct the study on Zoom to comply with shelter-in-place 
orders and COVID19 best prac9ces Study Endpoints/Events/Outcomes  
3.1. Primary Endpoint/Event/Outcome: The primary outcome is empirical data 
on the feasibility and acceptability of PPJ. We will also assess rates of 
substance use and treatment reten.on as primary outcomes.  
3.2. Secondary Endpoint(s)/Event(s)/Outcome(s): These include hypothesized 
mediators of the eﬀect of the interven.on on outcomes. These include: 
mood, sa.sfac.on with life, commitment to sobriety, alcohol and drug 
craving, anxiety, and depression. For a complete list, see the measures 
sec.on 5.2.  
4.
Study Interven9on(s)/Interac9on(s) 
4.1. Descrip.on: In-Depth Descrip9on of PPJ Interven9on. PPJ encourages past 
24-hour review and upcoming 24 hour planning to improve quality of life in 
recovery and reduce relapse. PPJ uses lined journals with column headings 
under which individuals make bullet-pointed lists. On the les hand page, 
past 24 hours is recalled, itemizing “good” and “bad” things that happened 
and things for which one is grateful. Good wishes for others are also 
expressed on this page. On the right hand page, ac.vi.es for the upcoming 
24 hours are planned via headings represen.ng valued life domains, such 
as “recovery,” “work/school,” “spirituality,” “home and household,” and 
“health.” 
PPJ invites par.cipants to open to a page in a journal we developed which 
has column headings represen.ng the diﬀerent categories on the les and 
right of the fold. See the ﬁgure below, which is a snapshot of the journal. 
The pages (or “ﬂaps”) on the far les and far right fold in and serve as 
bookmarks. The far les and right pages provide helpful hints for what to 
include under each column heading. Please note, minor changes have been 
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made to the wording that appears in this example. New wording has been 
uploaded to ethos, see ﬁle “PPJ Journal Text for IRB May 2020.” 
 
On the bo[om of the third panel “plan upcoming 24 hours” we added 
along the footer the following words: “observable measurable (where, 
when, how osen, how long, how much) smallest pieces possible” to help 
par.cipants to ar.culate tasks that are small and achievable.  
The les hand page is devoted to a structured review of the past 24 hours, 
and includes evidence-based gra.tude interven.ons including making a 
gra.tude list33,34 and the “Three Good Things” exercise.26 The “Three Good 
Things” exercise involves past 24 hour recall, iden.ﬁca.on, and recording 
of three posi.ve events that occurred that day (e.g., “warm exchange with 
cashier at dollar store”). The “gra.tude list” involves lis.ng items for which 
one feels thankful (e.g., “roof over my head”). Gra.tude list items are more 
global in nature. These two exercises approach gra.tude content via 
diﬀerent prompts to expand access to good things in life. The two exercises 
are dis.nct, but it is acceptable if they overlap (e.g., a “good thing” is listed 
on the “gra.tude list.”)  
The journal will also feature pages on which the par.cipants will write 
about their values for important life areas and iden.fy small, ac.onable 
items to move toward their values. Here is what that page looks like (please 
note we might make minor changes to the wording): 
Les hand ﬂap with 
sugges.ons
Les hand page
Right hand page
Right hand ﬂap with 
sugges.ons
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Also printed in the journal are instruc.ons for the “each one teach one” 
exercise, where par.cipants teach PPJ to another person. That page looks 
like this (please note we might make minor changes to the wording): 
 
The reasons we have included these pages (the values exercise pages and 
the each one teach one pages) is so that the par.cipants will have access to 
this informa.on within their journal, instead of miscellaneous pieces of 
notebook pages or handouts that can be separated from the journal itself. 
These materials might have las.ng value as reference material for the 
par.cipant. 
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Based on par.cipant feedback, we added approximately 10 pages of the 
journal that are lined pages with the word “notes” in the upper les corner 
of the double page spread. Par.cipants told us they wished the journals 
had space to capture addi.onal thoughts and observa.ons. It will also be a 
good place to take notes during journaling group. The notes page is 
uploaded to ethos.  
1.We will engage in several strategies to enhance par.cipants’ 
success with gra.tude interven.ons. Based on feedback from par.cipants 
in our previous gra.tude research, individuals will be coached that items on 
the “Three Good Things” list need not be monumental in scope but that 
small things count.17 Based on par.cipant feedback from previous research, 
individuals will be coached that items on the gra.tude list can include 
things osen taken for granted.17 Based on published gra.tude research, 
par.cipants will be provided with suggested areas in which to look for 
gra.tude content in their lives.35 In this way, gra.tude interven.ons will be 
modeled by the therapist and other group members.35 In keeping with the 
10th step from AA, the past 24 hour review will also include a bullet-pointed 
list of what did not go well in the past 24 hours. In our pilot qualita.ve 
work, we learned that par.cipants with expert knowledge of addic.on 
recovery described that lis.ng what did not go well in a day was useful.36 
Lis.ng what did not go well should be useful in forming plans for the 
upcoming 24 hours to address the nega.ve circumstances from the 
previous day. For example, one category heading on the right hand page in 
PPJ is “repair/amends” which oﬀers a venue for se_ng things right and can 
reference items from the les hand page. The les hand page also has a 
column wherein par.cipants can express well-wishes for someone else that 
they know is suﬀering or struggling. We will refer to this component as 
good wishes for others (WFO). This too can inform plans for the upcoming 
24 hours, e.g., it might prompt reaching out to that person to express 
support and thereby strengthen interpersonal bonds. Expressing well 
wishes for others is an act of kindness, and acts of kindness interven.ons 
have been studied as posi.ve psychology interven.ons to improve mood.37 
In PPJ, the right hand page is devoted to a structured plan for the upcoming 
24 hours, and includes ac.vity scheduling.15,38 Ac.vity scheduling prompts 
ac.on toward work-related and personal goals, posi.ve ac.vi.es, and self-
care behaviors each day. This work will focus on iden.fying important life 
areas, values, and ac.vi.es. First, par.cipants will be guided to select areas 
in life that are of most value to them (choosing from, e.g., mental health, 
physical health, educa.on/work, hobbies/recrea.on, rela.onships, and 
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spirituality). Next, par.cipants will be guided to ar.culate their values and 
ac.vi.es for chosen life areas. For example, in the life area “physical 
health” a value could be “feel good in my body” and a corresponding 
ac.vity could be “walk outside for 20 minutes.” Par.cipants will start with 
zero items each day (planning only) and build to achieving one item a day 
to avoid feeling overwhelmed and build a track record of success. 
Par.cipants will be encouraged to share their goals with their primary 
counselors at the host session in order to obtain support and help. 
5.
Procedures Involved 
5.1. Study Design: This study is a randomized control trial with a one-month 
follow up. In this mixed-methods study we will collect quan.ta.ve and 
qualita.ve data. Ques.ons related to feasibility and acceptability as well as 
hypothesized outcomes (increased treatment reten.on and decreased 
recurrence of substance use) and hypothesized mediators will be assessed 
quan.ta.vely via self-report ques.onnaire instruments and par.cipant 
treatment record, as described below. Qualita.ve data will focus on 
subjec.ve experiences of PPJ and logis.cs of study implementa.on. The 
spoken words of par.cipants during group and the wri[en content of their 
journals also comprise qualita.ve data that we will study. This has been 
outlined for the par.cipant in the informed consent document. Qualita.ve 
and quan.ta.ve data will be combined using integra.ve strategies 
recommended by Caracelli and Greene39 and Li, Marquart, and Zercher.40 In 
this integra.ve process, convergence across diﬀerent data sources will be 
documented, and divergence will be examined further to elucidate deeper 
understandings.41,42 Who will administer these measures? The quan.ta.ve 
measures will be assessed via electronic Qualtrics survey that the research 
par.cipants will access and complete themselves. (In the event there are 
technological diﬃcul.es, we might administer these surveys as paper 
ques.onnaires). At baseline, research staﬀ will hand the par.cipant the 
iPad (a computer can be used as back up) to complete the electronic 
Qualtrics survey. (For the electronic administra.on of this study, we will 
screen par.cipants on Zoom and send them the link to the survey in the 
Zoom chat or via text or email, or we will provide them with the url.) During 
group, the research staﬀ conduc.ng the group will hand out the iPads and 
par.cipants will use them to upload a picture of their journal entry and 
answer Qualtrics ques.ons. (For the electronic administra.on of this study, 
we will send the link to the survey to par.cipants electronically or give 
them the URL to navigate there themselves). Par.cipants will use their own 
smart phones or tablets. Outside of group sessions, NUWAY Staﬀ will make 
the iPads available for this same purpose (for electronic administra.on, we 
might retain a couple of iPads at the treatment center for clients to use 
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during face to face visits for drug screening or other purposes, following all 
COVID19 best prac.ces including social distancing). During the screening 
interview, we will provide some informa.on about how to use the tablets/
smart phones to access the surveys and take a picture of journal entries 
(for electronic administra.on, we will only provide this informa.on to the 
treatment group). When will these measures be administered? Please see 
Table 2 “Schedule of Assessments” below for the .meframe indica.ng 
when these measures will be assessed. Please note we might make minor 
changes to the wording of the Qualtrics survey, for example, to improve the 
wording of some instruc.ons to aid clarity or to correct typos and other 
small errors. 
2.The study is being conducted in collabora.on with our community 
partners for this study, NUWAY Inc. treatment center in Minneapolis, 
Minnesota.  NUWAY has been providing substance use disorder treatment 
remotely via Zoom groups and individual sessions shortly aser the COVID19 
crisis began. 
3.
4.NUWAY staﬀ par.cipate in many aspects of study implementa.on. 
NUWAY staﬀ assist with recruitment, they will complete a pre-screening 
check list for each client referred to us, they provide us access to the 
treatment rooms and oﬃces, they help us locate par.cipants and 
prospec.ve par.cipants who have appointments with us, and they 
disseminate the iPads among other du.es. For electronic administra.on, 
we will not use NUWAY treatment rooms or oﬃces. 
The counselors at the treatment center will review their caseloads and 
iden.fy prospec.ve par.cipants who meet all the criteria on the check 
sheet (a[ached). Counselors will inform eligible clients of the opportunity 
to par.cipate. Counselors will provide poten.al par.cipants with study 
contact informa.on and instruct them to reach out to study staﬀ to ask 
ques.ons and/or indicate their interest. If poten.al par.cipants prefer, they 
may give permission for the counselor to share their contact informa.on 
with study staﬀ. Study staﬀ will be responsible for ﬁnal screening and 
obtaining consent from interested families. Study staﬀ might also pre-
screen par.cipants using the counselor check sheet. 
We will use REDCap sosware to collect and organize study data including 
informa.on collected on the screening check list, recruitment and 
enrollment and reten.on data, group a[endance, study par.cipa.on, exit 
interview, and follow up interview data. We will also obtain consent 
signatures electronically using REDCap. 
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Please note that the wording described in all par.cipant-facing documents 
and ques.onnaires may be modiﬁed slightly to improve word choice or 
correct typos or other errors. 
We will use Zoom features such as sharing our screen, white board, polls, 
and wai.ng room to enhance learning and protect integrity of group 
sessions. 
We will teach basic Zoom skills (how to raise your hand, how to use the 
chat box, etc.). 
5.
5.2. Procedures. This study will be adver.sed to be a study of “journaling in 
recovery from addic.on.” All those interested in the study will be screened 
ﬁrst by NUWAY staﬀ to see if they meet basic criteria (see “prescreening 
guide for NUWAY staﬀ,” a[ached) and then by research staﬀ (using Zoom 
for electronic administra.on, see screening procedures, below). Aser 
screening and administra.on of the baseline assessment ba[ery, 
individuals will be randomized into treatment and control groups using 
randomly generated pairs of numbers or using REDCap’s randomiza.on 
procedure.  
Ac9vi9es of the control group. The control group will receive emails from 
the study team 3-7 .mes per week for 5 weeks (to mimic the assessment 
schedule of the treatment group). The control group, like the treatment 
group, will get a reminder email if they do not respond to our ﬁrst email 
aser several hours. Each email will contain a link to a Qualtrics survey. 
Control group par.cipants will complete the Qualtrics surveys and earn 
$5Target gis cards for doing so. Gis cards will be distributed electronically 
for electronic administra.on of this study. The control group will be able to 
accumulate the same number of gis cards as the treatment group. Aser 5 
weeks, control group par.cipants will be invited to par.cipate in a 
qualita.ve exit interview to ascertain their experiences with the study. At 
approximately one month aser the exit interview, control group 
par.cipants will be invited to par.cipate in a follow-up interview. At this 
interview, research staﬀ will ask par.cipants about any substance use and 
any journaling behavior. Aser the 30-day follow up, control group 
par.cipants will be given (or will be mailed using social distancing best 
prac.ces) a copy of the PPJ journal along with wri[en instruc.ons for how 
to use the journal (see “PPJ quick start guide,” a[ached). Please note, small 
changes to the quick start guide might be made such as small wording 
changes, ﬁxing of typos, changing examples to make them gender neutral, 
changing examples so that the language used matched the terminology 
used at the host se_ng. In addi.on, control group members will also be 
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given access to the study YouTube channel, which features short videos 
explaining how to use the journal. The ra.onale is that this will help the 
control group learn how to use the journal in more detail than the wri[en 
instruc.ons, so they have a be[er chance of ge_ng any beneﬁt from the 
journals. We will include a new cover le[er when we mail them the journal 
and the wri[en instruc.ons. This cover le[er will give them the URL for 
accessing the YouTube channel. A copy of this le[er has been uploaded to 
ethos. Treatment group par.cipants will be emailed or regular-mailed the 
PPJ quick start guide also, at the end of the group phase. 
Ac9vi9es of the treatment group. The treatment group will be assigned to 
a[end 8 hours of group sessions (for electronic administra.on, these 
sessions will be delivered via Zoom) in which PPJ journaling is taught in 
groups (which takes place over 2.5 weeks, and can be oﬀered in alterna.ve 
arrangements, for example, 4 2-hour sessions or other conﬁgura.on 
acceptable to the treatment host se_ng) followed by 2 weeks of 
independent journaling prac.ce, as described in detail below. They will 
earn $5 Target gis cards for their par.cipa.on, administered electronically. 
Aser 5 weeks, treatment group par.cipants will be invited to par.cipate in 
a qualita.ve exit interview to ascertain their experiences of the study and 
of journaling. At approximately one month aser the exit interview, 
treatment group par.cipants will be invited to a follow-up interview in 
which research staﬀ will ask par.cipants about any substance use and any 
journaling behavior. Exit and follow-up interviews will take place via Zoom 
for electronic administra.on. The treatment group will also receive emails 
from the study team reminding them to do the journaling and ﬁll out the 
Qualtrics ques.onnaire. The treatment group, like the control group, will 
get a reminder email if they do not respond to our ﬁrst email aser several 
hours.  
Emails to the treatment and control groups will contain encouraging 
statements such as, “well done” “thank you for your par.cipa.on in this 
research study” “we really appreciate your par.cipa.on in this research 
study” and other similar encouraging messages. We will also use 
structuring statements, such as “this is the ﬁrst email of the research study” 
or “this is the ﬁnal email of the research study” or “you are halfway 
through” or other similar structuring statements. We will also use 
statements to increase the validity of responses, such as “please answer as 
honestly as you are able” or “please put down the response that best 
matches how you really feel.” 
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Before any Zoom mee.ngs, group or one-on-one, we will send out a 
reminder with the Zoom link to email or text ahead of .me. We will send 
out reminders the day before and 10 minutes ahead of the mee.ng. 
To aid the treatment group in accessing the correct URL for uploading the 
photo of their journal and comple.ng the Qualtrics ques.onnaire, the QR 
Code and the URL to the Qualtrics survey will be printed on a front page of 
the journal.  
Please note, if any par.cipant has technological diﬃcul.es with Zoom or 
with study procedures that we cannot adequately address during group 
sessions, we might place the par.cipant with a research assistant in a Zoom 
break out room or make an appointment to meet with that par.cipant by 
Zoom or telephone to help solve the diﬃculty. 
See the table below for a summary of study ac.vi.es by arm. 
Study Ac9vi9es by Arm 
Baseline: All 
par9cipants
Randomiza9on
Phase 1. First 
2.5 weeks
Phase 2. 
Following 2 
weeks
Exit interview, 
immediately 
following 
Phase 2
Follow-up 
interview, 
approximately 1 
month later
Screening and 
assessment 
ba[ery 
All par.cipants 
con.nue with 
treatment as 
usual at the 
host se_ng 
throughout 
this study
Control Group
Complete 
Qualtrics 
surveys 3-4 
.mes a week, 
Earn gis cards
Complete 
Qualtrics surveys 
daily. Earn gis 
cards.
Interview with 
research staﬀ, 
Qualtrics 
survey.
Interview with 
research staﬀ, 
Qualtrics survey. 
Aser this 
interview, 
control group is 
mailed copy of 
journal with 
instruc.ons for 
i
it
Treatment Group
This is the 
“group phase.” 
A[end 
approximately 
8 hours of 
journaling 
groups. 
Complete 
Qualtrics 
surveys 3-4 
.mes a week. 
Earn gis cards.
This is the 
“independent 
prac.ce phase.” 
Journal daily. 
Complete 
Qualtrics surveys 
daily. Earn gis 
cards.
Interview with 
research staﬀ, 
Qualtrics 
survey.
Telephone 
interview with 
research staﬀ, 
Qualtrics survey.
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Detailed descrip9on of the ac9vi9es of the treatment group. There are 
three phases to this interven.on: the Group Phase (8 hours of content), the 
Independent Prac.ce Phase (2 week dura.on aser the group terminates in 
which par.cipants prac.ce PPJ 3-7 .mes per week), the Qualita.ve Exit 
Interview, which features the ﬁnal quan.ta.ve Qualtrics ques.onnaire and 
an in-depth semi-structured exit interview to ascertain sa.sfac.on with 
and cri.cism of PPJ, study logis.cs and the Follow-Up interview 30 days 
later which is a brief interview and ﬁnal Qualtrics survey. We will encourage 
comple.on of the quan.ta.ve Qualtrics ques.onnaire before the exit 
interview facilitated by research staﬀ for all research par.cipants. 
Par.cipants con.nue with treatment as usual during PPJ study ac.vi.es.  
The Treatment Group’s Group Phase. Par.cipants will meet for 8 hours of 
group content 2-3 .mes per week for 3 weeks to learn PPJ. For electronic 
administra.on, these groups take place via Zoom. 
PI Krentzman or another trained research staﬀ member will conduct these 
interven.on therapy groups. The primary aim of the groups is to teach the 
elements of PPJ. Groups and other Zoom mee.ngs will be audio recorded 
or Zoom’s instant audio transcrip.on tool will be used to aid treatment 
manual development and to collect qualita.ve data. Zoom mee.ngs will be 
video recorded (this happens automa.cally in Zoom), but client images will 
be edited out so as to completely remove them from the video recordings. 
These videos will be used by research staﬀ to learn how to lead the 
treatment groups. The videos will include the audio track and only images 
of our PowerPoint slides and research study staﬀ images. PPJ is taught by a 
counselor or group facilitator who themselves uses PPJ on a daily or near 
daily basis and the facilitator will prac.ce PPJ along with par.cipants in the 
group se_ng.  
A NUWAY Inc. staﬀ member will sit in on all group sessions. Study staﬀ 
(research assistants) may also sit in on group sessions and may lead group 
sessions in the unlikely event of any absence of the primary group leader. 
Amy Krentzman, primary inves.gator, would provide supervision and 
instruc.on in such an event. NUWAY Inc. staﬀ or research staﬀ will also 
prac.ce PPJ. Journals will be provided by the study to the study 
par.cipants. For electronic administra.on, journals will be mailed or 
delivered to the par.cipants and to the NUWAY staﬀ member. A set of 
journals will also be delivered to the NUWAY oﬃce as a backup. Clients can 
pick up a journal on a usual face-to-face visit to NUWAY for drug screening. 
Journals will have pre-printed category headings listed on the pages (see 
the ﬁgure, above) and other PPJ elements such as note pages, worksheets 
for describing values and instruc.ons for teaching PPJ to others. The study 
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will provide lap desks for par.cipants to use to lean on when wri.ng their 
journal entries unless we use a room with a table to lean on (this is not 
relevant to electronic administra.on). One addi.onal journal will be 
provided if the original journal is lost or stolen during the group sessions.  
Par.cipants will complete PPJ during group and will be invited to share 
some aspects of PPJ in a group process that will include modeling and 
coaching to support learning. During the sharing part of group, the 
facilitator and the NUWAY staﬀ member and the Research Assistant will 
also (judiciously) share their own PPJ entries. In between group sessions, 
par.cipants will be given homework to con.nue to prac.ce and therefore 
learn the elements of PPJ. Group par.cipants are also encouraged to share 
journal content judiciously as some content may feel private. Group 
par.cipants are also encouraged to protect their privacy by wri.ng some 
journal items using brief words, codes, or ini.als that would not be 
meaningful to another person. 
See Table 1 below for a detailed plan for each group session.  
Table 1. PPJ Treatment Group’s Group Phase Daily Session Content. Please note: this 
represents a general idea of content for each session. We will follow this general plan but 
the details (ac9vi9es, PowerPoint slides, topics, exercises) might be modiﬁed week by 
week. Prepara9on of detailed group session plans, handouts and PowerPoint slides (if 
used) might be conducted the day before or the morning of group sessions. Therefore, 
there would not be 9me to gain approval for these details from the IRB in advance of the 
group session. However, we will submit detailed group session plans, PowerPoints and 
handouts to the IRB as soon as they are ready and we are able to submit them in a 
modiﬁca9on to the study. 
Please note: some of these sessions might be conﬂated based on host seYng, for 
example, we might cover content of sessions 1 and 2 in a 2-hour session versus 2 1-hour 
sessions. 
Exactly what is covered in each session may vary based on pacing of diﬀerent groups but 
this sequence will be followed approximately.  
Week and 
Session #
Session Content
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Week 1, 
Session 1
Ice breaker, establish group rules, describe ra.onale for PPJ 
Recommenda.ons to protect privacy of journal contents 
Recommenda.ons for Zoom privacy 
A few words about wri.ng (no need to worry about spelling, grammar, etc.) 
Group schedule 
Du.es of the research team 
About your gis cards 
Introduc.on to the journal 
Introduce “Three Good Things” exercise (TGT) 
Provide .ps for success 
Prac.ce TGT exercise 
Sharing about the exercise 
Introduce lis.ng of what did not go well in the past day (i.e., “Bad Things”) 
Homework: Con.nue to prac.ce TGT exercise
Week 1, 
Session 2
Debrief: How did homework go? 
Prac.ce TGT exercise and Bad Things 
Introduce gra.tude list 
Provide .ps for success 
Prac.ce gra.tude list 
Sharing about the exercise 
Introduce “Good Wishes for Others” list 
Tips for journaling on your own 
Power moves: look through your “good things” and “bad things” and “gra.tude” lists 
and add their name to send them well wishes. For the right hand page: think of any of 
the people on your wishes list who you would like to reach out to extend your kind 
wishes. 
Sharing about the exercise 
Homework: Con.nue to prac.ce TGT exercise and gra.tude list exercise
Week 1, 
Session 3
Debrief: How did homework go? 
Teach back: invite a group member to describe what they have learned so far. 
More about the “bad things” list. Why do we treat it diﬀerently? Lecture on nega.vity 
bias, hedonic treadmill, changes to the brain during addic.on that make it harder to 
feel posi.ve emo.on and easier to feel stress. 
Provide .ps for success 
Sharing about the exercise 
Homework: Con.nue to prac.ce what we have learned so far.
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Week 2, 
Session 4
Debrief: How did homework go? 
Prac.ce TGT, gra.tude list, what did not go well, and WFO 
Provide .ps for success 
Sharing about the exercise 
More about the “bad things” list, some days in life will be challenging and the “bad 
things” list will be longer than the “good things list.” This is part of being human. 
Learning the right hand page. 
Rank order each life area. Write about what makes your top life area valuable and 
meaningful to you. 
Write about values for this life area. 
Teach how to write goals so that they are observable, measurable, and represent the 
next small step. Provide examples. 
Homework: Con.nue to prac.ce what we learned so far.
Week 2, 
Session 5
Debrief: How did homework go? 
Prac.ce les and right sides of the page 
Have par.cipants choose other life areas important to them 
Write about values, develop goals that are observable, measurable, and represent the 
next small step. 
Homework: Con.nue to prac.ce les hand and right hand side of the page
Week 2, 
Session 6
Debrief: How did homework go? 
Prac.ce les hand and right side of the page 
Choose more valued life areas (address the second important life area) 
Write about values for this life area 
Generate goals for each valued life area 
Prac.ce right hand side of the page 
Reminder not to discuss study ac.vi.es with other clients. 
Homework: Con.nue to prac.ce les hand and right hand side of the page
Week 3, 
Session 7
Debrief: How did homework go? 
Prac.ce les and right hand side of the page 
Learn the Each One Teach One exercise. Prac.ce the Each One Teach One exercise, 
which involves how to teach someone else the journaling prac.ce. 
Homework: Con.nue to prac.ce les hand and right hand side of the page. 
Homework: Each One Teach One: Find a person suppor.ve of your recovery who is not 
enrolled in the study. Teach them PPJ. Journal alongside them. Share content you wish 
to with each other.
Week 3, 
Session 8
Debrief: How did the Each One Teach One and homework go? 
Prac.ce les hand side of the page and right hand side of the page 
Sharing about the journaling prac.ce 
Group closure exercise, such as, the “What you got and what you brought” ac.vity 
where each group member writes down what they got out of the group and all other 
group members write down what each other member “brought” or contributed or 
other similar closing exercise. 
Homework: Move on to The Independent Prac.ce por.on of the study where PPJ 
con.nues independently over the next 14 days.
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When we address values, we will pay special a[en.on to the life areas 
selected by par.cipants and will help them iden.fy small, ac.on steps that 
are measurable and observable that they can take toward their goals in 
every life area. 
If we don’t have .me to capture journal entries completed during group, 
par.cipants might be asked to upload journal entries later in the day or use 
their own smartphones or tablets to complete the survey ques.onnaires 
for that day. 
If a group member misses group, we will ask for a volunteer from group to 
ﬁll that person in on what we did in group that day (this is likely to be 
irrelevant with electronic administra.on). 
From October 2020 forward, we will be crea.ng short video-recorded 
recaps of each group session that will be made available to study 
par.cipants 1) if they missed group and want to catch up on what we 
learned before returning to group the next session or 2) if they a[ended 
group but want a review of the content covered. We feel these recaps 
might aid reten.on because members who miss one group session might 
not want to return to group unless they learn the content they missed. Only 
the PI’s voice and image and PowerPoint slides will be included in these 
videos. These videos are op.onal for par.cipants to watch. The content on 
the videos is the same as the content of the group sessions and the 
PowerPoint materials are the same or very similar. No client faces, 
handwri.ng, or voices, or any iden.fying informa.on about clients at all 
will be included in these video recaps. When the ﬁnal text and PowerPoints 
and links to these videos are available we will submit them to the IRB. 
Individuals in the Maroon group who request an addi.onal journal at the 
one month follow up will be mailed an addi.onal journal. Based on 
availability, we might provide an older (but very similar) version of the 
journal. Individuals in the Gold group are mailed their ﬁrst journal at the 
one month follow up. If these journals are ﬁlled up, or any other similar 
reason, and the former par.cipant would like yet another copy of the 
journal, they can always request one from us and we will mail them an 
addi.onal journal as long as supplies last. 
For the control group and the treatment group: 
NUWAY counselors are responsible for the overall wellbeing of their clients. 
Therefore, NUWAY counselors will be informed of their client’s study 
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par.cipa.on. NUWAY counselors will be informed of group a[endance 
aser each group session to learn whether their client a[ended or not. 
Similarly, NUWAY counselors will be informed of the control group’s 
par.cipa.on in taking the Qualtrics surveys. 
If someone misses group or other study ac.vity for 2 days or 2 sessions in a 
row, we will reach out to them and gently encourage con.nued 
par.cipa.on, or inquire whether they wish to drop out of the study.  
At the screening mee.ng, we will also ask par.cipants how they would like 
to be contacted. By being in the study, they will agree to have us contact 
them by email since the ques.onnaires will be administered via email 
message. However, we will ask about a secondary way to reach the 
par.cipant such as text, telephone, snail mail, or other method) and if we 
need to reach the par.cipant for any reason, including to invite them to 
return to the study, we will use their preferred method. Aser reaching out a 
maximum of 2 .mes, we will not pursue the par.cipant further. We will 
con.nue to send them Qualtrics surveys, which they can feel free to ignore, 
in case they wish to resume study par.cipa.on. We will also invite 
par.cipants who have dropped out to an abbreviated exit interview (see 
Maroon group exit interview script). To send the person a journal, we will 
need their home address and will collect this informa.on at the screening 
interview. Par.cipants will also agree to using Zoom for study par.cipa.on. 
If a par.cipant misses the exit interview but presents for the 1-month 
follow up interview, we will use a new combina.on interview script to 
conduct that interview, and that interview will be audio recorded. If a 
par.cipant misses the exit interview and the 1-month follow up interview 
but presents at a more distal date, we will also use the new combina.on 
interview script and that interview will be audio recorded. The new 
combined script is a[ached to ethos. 
In general, counselors will be informed of their clients’ par.cipa.on. We 
will inform counselors of their clients’ par.cipa.on in study ac.vi.es. If 
there is a lapse in study ac.vi.es, we will let counselors know that their 
client is warmly welcomed to con.nue with study ac.vi.es. 
We will be certain to clearly communicate with counselors that they are not 
to put any pressure whatsoever on client par.cipa.on, par.cipa.on or lack 
thereof is en.rely the choice of the research par.cipant and no nega.ve 
consequences will result from par.cipa.on or lack thereof. 
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The Treatment Group’s Independent Prac9ce Phase. This phase begins 
when The Group Phase ends. During this phase, par.cipants will con.nue 
the journal prac.ce on their own over the next 14 days. Par.cipants are 
encouraged to complete PPJ a minimum of 3 .mes a week during this 
phase but they can feel free to complete PPJ daily if they would like to (they 
are compensated for up to 5 entries each week).  
Qualita9ve Exit Interview. At the end of the Independent Prac.ce Phase, 
par.cipants in the control and treatment groups will be invited to 
par.cipate in an individual (one-on-one) semi-structured qualita.ve exit 
interview to ascertain their experience of being in the study. For electronic 
administra.on, these mee.ngs will take place on Zoom. Treatment group 
par.cipants will also be asked about any poten.al impact or downsides of 
PPJ. Before the interview, par.cipants will be encouraged to complete the 
quan.ta.ve ques.onnaire that we are calling the “end of group and 
independent prac.ce phase” ques.onnaire, administered via Qualtrics. 
Ideally, these interviews will not be conducted by PI Krentzman but will be 
conducted by research staﬀ or perhaps by the University of Minnesota 
Oﬃce of Measurement Services in order to diminish socially desirable 
responses. 
Every eﬀort will be made to conduct the exit interviews in person, but 
when that is not possible, we will oﬀer the opportunity to complete the exit 
interview via Zoom, telephone or in wri.ng through email. For electronic 
administra.on, ﬁrst choice delivery will be Zoom followed by telephone or 
wri.ng through email.  
Follow-Up Interview. This takes place for treatment and control groups 30 
days aser the exit interviews. Here, par.cipants answer a few ques.ons 
about substance use and journaling since we met with them last. Before 
this interview, par.cipants will be asked to complete their ﬁnal Qualtrics 
ques.onnaire. 
Data Capture. Par.cipants in the treatment group will take a snapshot of 
their journal entries and upload this image to a Qualtrics survey to aﬃrm 
that assignments are completed; this skill will be taught and prac.ced 
during the screening mee.ng and Group Phase and prac.ced during the 
Independent Prac.ce Phase. Par.cipants will learn how to do this using 
Qualtrics and smartphones or tablets during group and will be able to 
con.nue to use their own smartphones or tablets to con.nue this prac.ce 
during The Independent Prac.ce Phase. Aser uploading the image of their 
journal, par.cipants will answer psychometric ques.onnaires in Qualtrics. 
Study iPads will be physically secured when not at use in a staﬀed oﬃce/
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supervised storage space (e.g., cabinet or drawer) at NUWAY. Par.cipants 
will be asked to complete their journal entries right before they upload 
them to Qualtrics. Individuals in the control group will simply ﬁll out the 
Qualtrics surveys at the same schedule as the treatment group. 
Par.cipants’ wri[en entries into their journals is also data of interest to us, 
including what they write and how many items they write under each 
category. NUWAY is outpa.ent versus our previous host site which was 
residen.al so we suspect there will be greater incidence of people arriving 
to group without their journals (having les them at home for example). 
Par.cipants will have the op.on to leave their journals on site at NUWAY 
with staﬀ in a supervised storage space (e.g., cabinet or drawer). Forge_ng 
one’s journal is less of a worry during stay-at-home electronic 
administra.on. 
Please note we will thank NUWAY staﬀ members by ci.ng NUWAY and 
perhaps individual staﬀ names in the acknowledgments sec.on of 
academic presenta.ons, posters, and manuscripts that result from these 
data. We may make periodic presenta.ons to NUWAY staﬀ about study 
observa.ons and ﬁndings throughout the study period and aserward. 
When appropriate, we will oﬀer CEUs for Social Workers to NUWAY staﬀ for 
their a[endance at these presenta.ons and host inexpensive lunches or 
coﬀee hours for NUWAY staﬀ (who are s.ll working from the oﬃce during 
COVID19 at this .me). When we are able, we will present NUWAY staﬀ with 
honoraria as a gesture of thanks for their help with recruitment. 
Data capture will also take place using REDCap. We will use REDCap to keep 
track of our screening procedures and study par.cipa.on ac.vi.es. 
Measures. Sociodemographic factors will be assessed at the ini.al baseline 
measurement (e.g., age, sex, marital status, years of educa.on, race/
ethnicity, employment status, and annual household income). A variety of 
psychometric scales will be used at baseline and throughout the study. 
Please see Table 2 for the Schedule of Assessments and the text following 
aser Table 2 for more detail about each assessment approach.  
Contents of Qualtrics survey and REDCap survey are described herein in 
full. 
Table 2. Schedule of Assessments. 
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How 
long 
does it 
take to 
complet
e each 
of these 
measure
Baseline
At Every 
PPJ 
Qualtric
s upload
Asked 
or 
Tallied 
aser 
Group 
Phase 
Ends 
(Phase
Asked or 
Tallied 
aser 
Independe
nt Prac.ce 
Phase Ends 
(Phase 2)
Final 
Study 
Ac.vi.e
s 
includin
g 1 
Month 
Follow
Baseline characteris9cs
Sociodemographics, including 
current housing situa.on, i.e., “are 
you now living in sober living?”
3 
minutes
X
Hospital Anxiety and Depression 
Scale
3 
minutes
X
X
X
X
10-item SIP-AD, addic.on 
consequences
5 
minutes
X
Commitment to Sobriety (full scale)
2 
minutes
X
X
X
X
Trait gra.tude
2 
minutes
X
X
X
X
AA Aﬃlia.on Scale
2 
minutes
X
Exposure to trauma
1 
minute
X
Using Medica.on Assisted 
Treatment?
½ 
minute
X
Legal issues: current involvement in 
civil legal case and current 
involvement in criminal court case
½ 
minute
X
Sa.sfac.on with treatment
2 
minutes
X
X
X
Social Desirability Scale
4 
minutes
X
Open ended ques.ons: Experience 
with 10th step, journaling, gra.tude 
prac.ces, and using a planner. 
4 
minutes
Verbally 
administ
ered 
using 
REDCap
Verbally 
administer
ed using 
REDCap
Verbally 
administ
ered 
using 
REDCap
What have you already heard about 
the study?
1 
minute
Verbally 
administ
ered 
using 
REDCap
Hypothesized Mediators
Posi.ve and Nega.ve Aﬀect 
Schedule, including three items 
comprising the serenity subscale 
(calm relaxed at ease)
2 
minutes
X
X
X
X
X
Abs.nence Self Eﬃcacy Ques.on 
(single item)
1 
minute
X
X
X
X
X
Commitment to Sobriety (single 
item)1
2 
minutes
X
X
X
X
Alcohol craving (single item)
½ 
minute
X
X
X
X
X
Drug craving (single item)
½ 
minute
X
X
X
X
X
Happiness with Recovery (single 
item)
½ 
minute
X
X
X
X
X
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Baseline characteris.cs. 
●
Sociodemographics 
Exposure to trauma. Par.cipants who have experienced addic.on have high 
rates of exposure to trauma. We will ask about exposure to trauma in order 
Individual items to assess speciﬁc 
impact of PPJ journaling prac.ce1 
(a[ached as “single items to assess 
change ”)
3 
minutes
X
X
X
X
X
Sa.sfac.on with Life
1 
minute
X
X
X
X
X
Quality of life scale, modiﬁed to 
compare quality of life during 
recovery (“now”) to quality of life 
during ac.ve addic.on (“then”)1
3 
minutes
X
Global 
quality 
of life 
item 
only
X
X
X
Flourishing scale
2 
minutes
X
X
X
X
Treatment Group Only
# of Qualtrics surveys completed
X
X
X
Ease, helpfulness, sa.sfac.on, eﬀort 
of PPJ (for control group, ease, 
helpfulness, sa.sfac.on, eﬀort of 
ﬁlling out the survey ques.onnaires)
2 
minutes
X
X
X
# group sessions a[ended
X
# homework assignments completed
X
# journal entries completed
X
X
Count of # of items entered into PPJ
X
X
X
X
Eligibility rate and consent rate 
(treatment and control group)
X
On approximately the fourth session 
of group (halfway through the total 
# of sessions) ask: “what is working 
for me in this journaling group is….” 
And “what is not working for me in 
this journaling group is ”
Open Ended Survey Ques9on
Treatment group: What are your 
thoughts about Posi.ve Peer 
Journaling (PPJ) so far?
2 
minutes
X
X
Outcomes
Recurrence of Substance Use
X
X
X
Treatment Reten.on at NUWAY 
(successfully exi.ng treatment with 
staﬀ approval versus against staﬀ 
advice or at staﬀrequest)
X
X
X
Qualita9ve Exit Interview
45 
minutes
X
1 month follow up interview
25 
minutes
X
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to describe the sample, that is, to report what percentage of the sample 
has been exposed to trauma. To determine exposure to trauma, we will use 
the ﬁrst ques.on from The Pos[rauma.c Diagnos.c Scale.43 The ﬁrst 
ques.on of this instrument asks if the par.cipant has ever experienced life 
threatening illness, physical assault, sexual assault, military combat, child 
abuse, accident, natural disaster, or other trauma. Par.cipants will be 
informed that we will be asking about this in the informed consent 
document. Please note, we will not assess for symptoms or eﬀects of 
trauma since our objec.ve is to use the single item to describe the sample. 
NUWAY regularly screens all residents for trauma. However, if any 
par.cipant has diﬃculty with study ac.vi.es because of trauma or any 
other reason, we will inform NUWAY. If par.cipants experience distress 
related to this trauma ques.on or any other element of the baseline 
ques.onnaire or screening interview, we will refer them to NUWAY staﬀ.  
●
Legal involvement. Par.cipants with severe addic.on histories such 
as those in our study have greater rates of involvement with the 
legal system. Therefore, to be[er deﬁne our popula.on, we will ask, 
“Are you currently involved in a civil legal case? Are you currently 
involved in a criminal court case?” 
●
Medica.on Assisted Treatment (MAT). Par.cipants with severe 
addic.on histories are osen prescribed speciﬁc medica.ons to 
reduce substance use and cravings. Therefore, we will add two 
items to determine if par.cipants in our sample are using MAT to 
support their recovery. We ask if they are using MAT and if so, for 
what substance. For the speciﬁc items, see the baseline 
ques.onnaire a[ached to ethos. 
●
Symptoms of anxiety and depression will be assessed using the 
Hospital Anxiety and Depression Scale.44 
●
Severity of addic.on consequences will be assessed using the 10-
item version of the Short Inventory of Problems-Alcohol and Drugs 
scale (10-item SIP-AD).45 
●
Mo.va.on to remain abs.nent will be assessed by the Commitment 
to Sobriety Scale.46 
●
An individual’s disposi.on toward gra.tude will be assessed with 
the GQ-6 Gra.tude Scale.47 
●
12 step aﬃlia.on will be assessed via the AA aﬃlia.on scale48 
●
Sa.sfac.on with treatment at NUWAY will be assessed via a 
treatment sa.sfac.on scale.49 In previous research, par.cipants 
who received behavioral ac.va.on treatment for substance use 
disorders had higher treatment sa.sfac.on than individuals in the 
control group.  
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●
A par.cipant’s concern with social approval will be assessed with 
the Marlow-Crowne Social Desirability Scale.50 
●
We will ask what they already know about this research study 
(counselors or other clients at the treatment center might have 
men.oned things about the study). These will be a qualita.ve open-
ended ques.ons. 
●
Quality of life “now” in recovery compared with “then” in ac.ve 
addic.on will be assessed by a modiﬁed version of the EUROHIS 
Quality of Life instrument. 51  
Hypothesized mediators. 
●
Aﬀect will be assessed with the Posi.ve and Nega.ve Aﬀect 
Schedule and the Serenity subscale of this instrument.52 
●
Self-conﬁdence in a par.cipant’s ability to abstain from addic.ve 
substances will be assessed by the Abs.nence Self Eﬃcacy Scale 
Ques.on: “How conﬁdent are you that you will be able to stay clean 
and sober in the next 90 days, or 3 months?”.53 
●
Commitment to sobriety (single item) “I will do whatever it takes to 
recover from my addic.on.”  
●
Alcohol craving (single item) “Rate the strongest urge to drink you 
have experienced in the past 7 days” 
●
Drug craving (single item) “Rate the strongest urge to use drugs you 
have experienced in the past 7 days” 
●
Sa.sfac.on with recovery (single item) “In general, I am happy with 
my recovery” 
●
Sa.sfac.on in Life will be assessed with the Sa.sfac.on with Life 
Scale.54 
●
Flourishing will be assessed with Diener’s Flourishing Scale.55  
●
We developed several single items to assess change that is directly 
related to the ac.vi.es of the journaling prac.ce. These items are 
uploaded to ethos as “single items to assess change”.  
●
We ask whether the person a[ended a mutual aid group in the past 
24 hours (such as Alcoholics Anonymous).  
●
It will be important to know whether par.cipants are already doing 
aspects of the journaling prac.ce. Therefore, at baseline, at the exit 
interview, and at the 3 month follow up, we will ask par.cipants 
these ques.ons verbally and we will record answers in REDCap or 
we will ask these ques.ons in Qualtrics: 
o
What kind of journals or diaries do you keep, if any? (If in the 
treatment group, what kinds in addi.on to PPJ?) Tell me 
about your use of journals or diaries over the past month. 
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o
Tell us about any gra.tude prac.ces you have been doing 
over the past month, if any. (For treatment group, ask about 
any gra.tude prac.ces in addi.on to PPJ). 
o
Tell us what the 10th step means to you. What kind of 10th 
step have you been doing, if any, over the past month? (For 
the treatment group, ask if they have been doing any 10th 
step in addi.on to PPJ). 
o
What kind of planner or calendar do you keep, if any? What 
has your use of this planner been like over the past month? 
(for the treatment group, what have they been doing in 
addi.on to PPJ, if anything?) 
o
(at exit interview and follow up interview) Tell us about any 
.mes that you talked about your experience being in this 
study with other people, such as family members, 
housemates, your counselors, or others, if at all. 
Eﬀort, Feasibility, and Acceptability. 
●
# of Qualtrics surveys completed 
●
Eﬀort, Ease, helpfulness, sa.sfac.on (one item to assess each: “For 
this PPJ, I would say I put forth this much eﬀort…” Degree to which 
PPJ was diﬃcult, helpful, sa.sfying, easy, rated on a 0-10 point scale) 
●
# of group sessions a[ended 
●
# homework assignments completed 
●
# journal entries completed 
●
Eligibility rate: Number eligible/total at NUWAY site 
●
Consent rate: Number consented/number screened 
●
Group comple.on rates 
●
Independent prac.ce phase comple.on rates 
●
# PPJs uploaded 
●
# PPJs completed 
●
% of PPJs completed out of total # of possibili.es to complete PPJ 
●
# of items entered under each category 
●
Qualita.ve data from group discussion and exit interviews 
Open-ended survey ques.on. 
●
What thoughts would you like to share with us about being in this 
research study, if any? 
Outcomes. 
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●
Recurrence of substance use.  
●
Reten.on of treatment in NUWAY 
●
NUWAY reason for leaving 
●
Qualita.ve data from group discussion or exit interviews 
Recurrence of substance use and treatment reten.on will be assessed via 
NUWAY treatment record. Research staﬀ will not have direct access to the 
NUWAY treatment record. A NUWAY staﬀ member will meet with research 
staﬀ at reasonable intervals to report informa.on about treatment 
reten.on and recurrence of substance use for study par.cipants from the 
NUWAY treatment record (for electronic administra.on, these mee.ngs will 
be via Zoom or telephone). Recurrence of substance use is assessed at 
NUWAY by posi.ve urine analyses (UAs) and other drug screens as well as 
resident self-report. At or aser this mee.ng, research staﬀ will use the 
password protected electronic document which links par.cipants’ real 
names with their study codenames/numbers. Research staﬀ will use this 
key to record the informa.on from NUWAY staﬀ into a de-iden.ﬁed 
database (e.g. excel or SPSS or Google drive) or into REDCap. 
Dr. Amy Krentzman, the lead inves.gator, will keep a log/personal notes 
throughout the study, qualita.vely recording observa.ons, especially 
during recruitment and aser each class session. 
A de-iden.ﬁed par.cipant tracker will be maintained on Google drive using 
only par.cipant codenames to track group a[endance, independent 
prac.ce phase ac.vity and other study ac.vi.es. 
Analysis Plan.  
Sample characteris.cs. We will aggregate informa.on about the 
demographics and baseline characteris.cs of the study to be able to 
describe the psychosocial, demographic, and clinical proﬁle of study 
par.cipants. We will calculate means and standard devia.ons for 
con.nuous measures (e.g., age) and calculate percentages for categorical 
measures (e.g., marital status). 
Primary feasibility and acceptability measures. We will aggregate 
informa.on designed to assess feasibility and accessibility such as number 
of Qualtrics surveys completed, group sessions a[ended, journal entries 
completed, as well as par.cipant assessment of the diﬃculty, ease, 
helpfulness, sa.sfac.on, and eﬀort expended on PPJ. We will sum these 
items and calculate means and standard devia.ons.  
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Secondary measures: outcomes and mediators. We will compare rates of 
treatment reten.on and recurrence of substance use to the general rates 
reported by NUWAY. We will also examine pre-post treatment means and 
standard devia.ons of hypothesized mediators (aﬀect, sa.sfac.on with 
recovery, individual items theore.cally related to PPJ) to determine if 
change is in the expected direc.on. We will also study these constructs to 
determine if there is reasonable variability in the data we collect or if ﬂoor 
or ceiling eﬀects are present. We may also use single-subject designs56 to 
depict change over .me in key constructs by study par.cipant. Qualita.ve 
data will be thema.cally analyzed using the techniques recommended by 
Braun and Clarke.13 Here, the researcher examines transcripts of texts and 
iden.ﬁes key themes and how themes relate to one another. These data 
will inform interven.on development and study implementa.on 
procedures. 
Data analy9c techniques to compare treatment and control groups. While 
this pilot study will not be adequately powered to detect signiﬁcant eﬀects 
between treatment and control groups, we will compare diﬀerences 
between the treatment and control groups at baseline and over .me using 
either t-tests or mul.-level modeling. T-tests will reveal signiﬁcant 
diﬀerences between groups and mul.-level modeling will show whether 
rate of change is signiﬁcantly diﬀerent between groups. 
Data Collec9on Methods. The University of Minnesota allows faculty and 
researchers access to Qualtrics sosware. Qualtrics is an online sosware 
survey program which collects survey data. We, along with the University of 
Minnesota Oﬃce of Measurement Services, will program Qualtrics to 
administer the self-report measurements discussed in the Measures sec.on 
at baseline, throughout group, during the independent phase, and at the 
exit interview. At baseline, we will provide par.cipants with an electronic 
tablet (iPad or smartphone) (if necessary we will use a computer at 
baseline or at other measurement occasions) so they can access the 
baseline assessment via Qualtrics. Study staﬀ will sit unobtrusively in the 
same room with par.cipants as they complete the baseline assessment (for 
electronic administra.on, we will stay on the Zoom mee.ng while the 
par.cipant ﬁlls out the Qualtrics Survey). Par.cipants will be invited to ask 
ques.ons of study staﬀ as they complete the survey. Once the Group Phase 
begins, par.cipants will take a snapshot of their PPJ entries and upload 
them to Qualtrics during group and independently during the Independent 
Prac.ce Phase. Study therapists will teach par.cipants how to do this 
during The Group Phase.  
The speciﬁc procedural steps that we will take to conduct this study 
include: 
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●
Present the study to clinical staﬀ / leadership at NUWAY to gain 
se_ng-based insights and situate the interven.on successfully in 
context. 
●
Train NUWAY staﬀ on their par.cipa.on in the study, that is, 
iden.ﬁca.on of prospec.ve par.cipants. This includes reviewing 
the study with the prospect to determine interest, having the 
prospect sign up for a screening mee.ng with study staﬀ, providing 
study ﬂiers (electronically) to interested persons. NUWAY staﬀ will 
take no further ac.on if the prospect is not interested. NUWAY staﬀ 
might also sit in on group sessions, and lend out the iPads (during 
electronic administra.on, using the study iPads at NUWAY will be 
rare). NUWAY counselors will receive emails informing them of 
par.cipant ac.vity in the study, such as group a[endance. 
●
Work with U of M (Oﬃce of Measurement Services) Qualtrics 
survey developer to use Qualtrics to capture data. 
●
Recruitment and randomiza.on.  
●
Assess hypothesized treatment outcomes such as increased 
treatment reten.on and decreased recurrence of substance use. 
Assess hypothesized mediators such as sa.sfac.on with recovery 
and improved mood. For a complete list, see the measures sec.on. 
●
Assess feasibility and acceptability of The Group Phase and The 
Independent Prac.ce Phase for the treatment group. 
●
Conduct qualita.ve exit interviews to ascertain par.cipants’ 
subjec.ve experiences of the interven.on (treatment group), study 
logis.cs, relevance to recovery in rural communi.es (treatment 
group), and feasibility and acceptability of the interven.on 
(treatment group). A quan.ta.ve Qualtrics survey will also be 
administered at this mee.ng. 
●
Conduct one-month follow up interviews. Ask about substance use 
and journaling behavior. Par.cipants can par.cipate in follow up 
interview even if they skip the exit interview for whatever reason. 
Par.cipants complete the ﬁnal ques.onnaire at this .me. 
●
Study and reﬁne recruitment processes, reten.on ability, 
func.oning of Qualtrics surveys, and feedback about feasibility and 
acceptability. Create IRB amendments as needed. 
5.3. Exit Interview: Aser the ﬁrst 5 weeks of the study (for those in the 
treatment group, this 5 week period aligns to The Group Phase and The 
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Independent Prac.ce Phase) par.cipants will be invited to par.cipate in a 
qualita.ve exit interview with research staﬀ. If the resident has been 
discharged from NUWAY on good terms during the course of the study, we 
will reach out to them and invite them to an exit interview. We would 
contact the person at the forwarding informa.on on ﬁle at NUWAY. The 
par.cipant will have given informed consent for this in the informed 
consent document. We will meet with par.cipants at NUWAY or in their 
home or at a local library or other reasonable loca.on that oﬀers privacy 
(during electronic administra.on, we will meet with them over Zoom). The 
research study will pay round trip for a taxi or Uber or similar ride program 
for the par.cipant to meet us for the Exit Interview (we will not use this 
op.on during electronic administra.on). Par.cipants will also be 
encouraged to call us to schedule the Exit Interview. 
If par.cipants leave NUWAY on good terms during the study period, they 
may s.ll be able to con.nue to be in the study because it is possible to 
con.nue study ac.vi.es from outside of NUWAY for the independent 
prac.ce phase. Any smartphone or tablet can be used to con.nue to 
par.cipate in the independent prac.ce phase. We may reach out to 
par.cipants who con.nue to par.cipant in this way to encourage them to 
con.nue in the study or ask if they wish to remain in the study using the 
contact informa.on they provide to use through NUWAY Inc. 
Follow up Interview: At approximately 30 days aser the exit interview, we 
will follow up with par.cipants. Zoom is the ﬁrst choice but a telephone 
interview is acceptable for this procedure. We will ask par.cipants about 
any substance use and journaling in the past 30 days. We will ask a few 
addi.onal qualita.ve ques.ons such as what was most memorable about 
being in the research study, and other similar ques.ons. Par.cipants will be 
encouraged to complete their ﬁnal Qualtrics survey before this interview. 
5.4. Individually Iden.ﬁable Health Informa.on: Research study staﬀ will meet 
with NUWAY staﬀ at reasonable intervals to collect data on our primary 
outcomes: 1) treatment reten.on and 2) recurrence of substance use. At 
these occasions we will go through our list of study par.cipants and ask 
NUWAY staﬀ if: 1) that person has les treatment or been asked to leave; 2) 
that person has had a posi.ve urine analysis screening indica.ng 
recurrence of substance use. We will mark down the replies in our 
deiden.ﬁed data ﬁle. If the par.cipant cannot remember date of entry into 
NUWAY, we will also gain this informa.on from NUWAY staﬀ and the 
treatment record. To facilitate this work, study staﬀ will use a password-
protected ﬁle linking par.cipants’ real names with study IDs (codenames/
numbers). 
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6.This study therefore includes PHI and therefore we have combined 
our informed consent document with the appropriate text from a HIPAA 
authoriza.on form.  
We have been informed that we do not need to complete a University’s 
Health Informa.on Privacy & Compliance Oﬃce (HIPCO) online applica.on 
for data privacy and security review as the PI, Dr. Krentzman, is not within 
the University of Minnesota Academic Health Center. For this same reason, 
we were also informed that Dr. Krentzman can use her University of 
Minnesota Zoom account and need not use the Academic Health Center 
version of Zoom. The Zoom accounts we will use for this study belong to 
the University of Minnesota, Dr. Krentzman and/or study staﬀ. 
5.5. Addi9onal procedure for obtaining feedback on the PPJ journal. I will 
provide copies of the PPJ hard-copy journal and how-to instruc.ons to 
colleagues, students, and members of the community during lectures I give, 
mee.ngs I have, and in other contexts. I will invite individuals to use the 
journal and provide feedback to me about their experiences using it. The 
feedback I receive would be useful in op.mizing the journal. I would invite 
users to provide feedback to me via email, regular mail, or telephone calls/
voice messages. I would keep de-iden.ﬁed notes on this informa.on and 
use the feedback to improve the journal. 
6.
Data Banking 
6.1. Storage and Access: Quan.ta.ve data will be stored in a spreadsheet or 
data analy.c sosware ﬁle and this data will be de-iden.ﬁed. Qualtrics will 
be used to collect data prior to download. Qualtrics is HIPAA compliant. 
Cases will be iden.ﬁed by code name or number only. Using a successful 
strategy we have used in the past, at baseline, par.cipants will be asked to 
provide a “codename or number” that does not contain iden.ﬁers such as 
real name or birthday. Examples from the past have included “Rusty” or 
“007.” An electronic key linking par.cipants’ real names with codenames/
numbers will be held on the PI’s and research staﬀs’ laptops in a password-
protected ﬁle. This ﬁle will be deleted one year aser the manuscripts based 
on this research are accepted for publica.on. Only the PI and research 
team will have access to the data. Codenames and real names are also 
listed on the “codename” sheet that individuals ﬁll out at baseline when 
choosing their codename. These pages are kept in a locked ﬁle box or ﬁling 
cabinet. We will also store certain kinds of data in University of Minnesota 
Box Secure Storage. Box Secure Storage is HIPAA compliant and is used for 
sharing conﬁden.al ﬁles. See h[ps://it.umn.edu/services-technologies/
box-secure-storage. We will use Box in two primary ways. First, we will 
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share research ﬁles with research team members whose computers cannot 
join VPN to access the secure drive. Second, we will use Box to share signed 
par.cipant informed consent documents with the host treatment provider, 
NUWAY, if they would like to ﬁle these documents in their clients’ 
treatment records. Other similar uses of Box Secure Storage might be 
employed for quan.ta.ve and qualita.ve data and other research ﬁles.  
Qualita.ve data will be stored in several formats. Audio recordings of group 
sessions and of exit interviews and video recordings that feature the audio 
track and video images only of study stuﬀ will be stored only on the secure 
U of M School of Social Work Shared Drive server. We might alterna.vely 
use Zoom’s automa.c electronic transcrip.on service. Uploaded pictures of 
PPJ entries will be shared on this same Shared Drive server. Transcripts of 
the audio recorded sessions will also be uploaded here and will be de-
iden.ﬁed before qualita.ve data analysis. Once the transcrip.ons have 
been de-iden.ﬁed, then de-iden.ﬁed transcrip.ons and qualita.ve data 
sosware can be saved outside of the shared drive. The Shared Drive Server 
at the School of Social Work is an access control list (ACL) controlled ﬁle 
server. This means that each user has diﬀerent access depending on which 
Ac.ve Directory Groups they are in. The folder on the drive where the data 
would be saved would have its own Ac.ve Directory group, and only 
research team members (and the server administrators) would have access 
to the ﬁles in the folder. We have been advised by Informa.on Technology 
professionals at the School of Social Work that these security provisions are 
in line with the University of Minnesota data security provisions including 
the storage of research study data. De-iden.ﬁed transcripts of these 
sessions will be kept on the U of M server and/or the PI’s and research 
teams’ laptops. Transcripts are created by an outside vendor, Datagain 
(datagainservices.com). Datagain is a transcrip.on service for research. 
Datagain oﬀers data encryp.on on all stored data, secured data transfers, 
compliance with ISO 9001 and HIPAA standards, and regular security audits. 
If needed, we will use a diﬀerent company than Datagain but one with all of 
the same protec.ons and security provisions. We might use Zoom’s 
automa.c electronic transcrip.on service instead of Datagain. 
6.2. Data: The data elements to be collected and banked for future use in a de-
iden.ﬁed data set include all those listed in the measures sec.on of this 
protocol. We will also store jpg ﬁles represen.ng the snapshots of the 
uploaded PPJs.   
6.3. Release/Sharing: N/A 
7.
Sharing of Results with Par9cipants 
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7.1. Par.cipants will be encouraged to email or call the PI in about a year’s .me 
to obtain study results in the form of academic posters or academic 
manuscripts or other products. Upon such requests, the PI will email or 
send via regular mail these products as well as an easy-to-understand fact 
sheet summarizing the results to date, to improve accessibility to study 
ﬁndings for lay readers. This opportunity is men.oned in the informed 
consent document. In general, the PI will share research ﬁndings at 
community-based, local, regional, and interna.onal conferences, during 
class or other lectures, and will publish study ﬁndings in academic journals. 
We will also make a presenta.on of ﬁndings to NUWAY staﬀ when the 
study is over and throughout the study, as requested by NUWAY.  
8.
Study Dura9on 
8.1.
●
The dura.on for an individual par.cipant’s par.cipa.on in the study is 
an.cipated to be ﬁve to nine weeks as follows: Phase 1: 2.5 weeks, 
Phase 2: 2 weeks, a qualita.ve exit interview to take place as soon as 
possible at the 5 week mark, and a follow-up interview approximately 
30 days aser the exit interview.  
●
The dura.on an.cipated to enroll all study par.cipants: Enrollment 
will be rolling. We will recruit 10-20 individuals at a .me to populate 
1-2 treatment groups and corresponding individuals for the control 
groups. This study will last approximately 2 years. Typically, we will 
screen and consent and enroll par.cipants during the week before 
groups start. 
●
The dura.on an.cipated to complete all study procedures and data 
analysis: Including manuscript produc.on and publica.on, 
approximately four years. 
9.
Study Popula9on 
9.1. Inclusion Criteria: 1) minimum 18 years of age, 2) meet DSM-V criteria for 
past-year SUD as primary or secondary diagnosis, 3) English literacy 
suﬃcient to make short wri[en lists needed to complete PPJ and 
homework assessments, 4) minimum approximately 2 weeks sustained 
abs.nence (ideally > 10 days), 5) completed ﬁrst 2 weeks of treatment at 
NUWAY (approximately 2 weeks), 6) agree to be audio recorded / 
transcrip.on recorded in group mee.ngs and in individual mee.ngs with 
research staﬀ, 8) currently are clients at NUWAY, 9) par.cipants must be 
English speaking and literacy must be strong enough to write short lists and 
to understand the ques.ons asked in the Qualtrics survey, 10) have an 
email address and are willing to check it regularly and use it to receive 
study communica.ons, 11) have a device that has a camera for Zoom 
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par.cipa.on and to take pictures and is connected to the internet, such as 
a smartphone or tablet, 12) has access to high speed internet. Many 
NUWAY par.cipants live in Sober Living Housing with internet provided. 
Priority will go to par.cipants who will be in treatment at NUWAY for the 
dura.on of the study ac.vi.es (and not discharging aser one week, for 
example). 
The par.cipants in treatment at NUWAY are individuals with low or no 
income and histories of severe substance use disorder. Therefore in the list 
below we checked that they are “disadvantaged in the distribu.on of social 
goods and services such as income, housing, or healthcare” and, as 
individuals with addic.ve disorders, we also checked that they are from an 
“undervalued or disenfranchised social group.” 
All par.cipants will be 18 or over. NUWAY on occasion will have a client 
younger than 18, but they will not be eligible for this study. 
9.2. Exclusion Criteria: 1) presence of a psycho.c disorder, psychiatric condi.on 
(e.g., suicidal idea.on), or cogni.ve impairment (e.g., severe demen.a, 
trauma.c brain injury) limi.ng ability to give consent and/or par.cipate in 
the study; 2) severe psychiatric illness (current schizophrenia, major 
depression with suicidal idea.on); 3) personality disorders that would 
interfere with sa.sfactory par.cipa.on in or comple.on of the study 
protocol, 4) inability to give informed, voluntary consent to par.cipate, 5) 
lack of suﬃcient English literacy to par.cipate, deﬁned as inability to make 
a list of 5 things they did yesterday and inability to understand Qualtrics 
survey ques.ons, 6) any impairment, ac.vity, or situa.on that in the 
judgment of the research staﬀ would prevent sa.sfactory par.cipa.on in or 
comple.on of the study protocol, 7) the unlikely event that the par.cipant 
is already doing something very similar on a daily basis such as a wri[en 
10th step and a daily ac.on plan, 8) no access to a phone/tablet or internet 
connec.on.  
7.See the a[ached document “Recruitment, Screening, Consent, 
and Baseline Script.” This document shows how each of the inclusion/
exclusion criteria will be assessed during the recruitment and screening 
phase of the study.  
9.3. Screening: The screening process will proceed as follows. 
1) NUWAY staﬀ will iden.fy clients who might be eligible. NUWAY staﬀ will 
complete the “pre screening guide” to make sure that a client meets basic 
study criteria. Prospec.ve par.cipants who meet these criteria will be 
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given a study ﬂyer (see a[ached, an electronic version of the ﬂyer will be 
sent to clients), and will have the opportunity to sign up to have an 
appointment with Research Staﬀ at NUWAY to con.nue the screening and 
informed consent process, or call research staﬀ to ask ques.ons.  
2) When prospec.ve par.cipants meet with Research Staﬀ, Research Staﬀ 
will follow the recruitment, screening, consent, and baseline script 
(uploaded to Ethos). During this interview, prospec.ve par.cipants will 
complete a set of ques.onnaires and consent forms, speciﬁcally: the 
Screening Consent Form, Informed Consent Form, UBACC quiz to 
determine capacity to consent,57 the HIPAA Authoriza.on form, the GAIN 
SS58,58,59 instrument to determine presence of a psycho.c disorder, 
psychiatric condi.on (e.g., suicidal idea.on), severe psychiatric illness, and 
personality disorders, the GAIN Cogni.ve Impairment Ques.onnaire. See 
“Recruitment, screening, consent, and baseline script” document uploaded 
to Ethos for details. All of these instruments and documents are a[ached. 
Please note, the Screening Consent Form and Informed Consent Form were 
created using University of Minnesota templates, but some of the language 
was modiﬁed to reduce the reading grade level of the documents from 
approximately 10th grade reading level down to 7th grade reading level, 
which is more appropriate for this research sample.  
3) When prospec.ve par.cipants meet with Research Staﬀ, they will also 
do one ac.vity: they will be asked to write a list of 5 things that happened 
yesterday. Research staﬀ will examine this list to determine if the individual 
has adequate literacy and wri.ng skills to be part of the study since PPJ 
requires wri.ng of short lists. This criteria will also apply to the control 
group so that inclusion criteria are equivalent for the two groups. 
4) The screening interview will take place as follows: 
1. Par.cipant will have been given the study main consent form in 
advance by NUWAY staﬀ, ideally (this is unlikely to occur during 
remote delivery), and will have been asked to read it. They will have 
the chance to ask any ques.ons. 
2. Screening consent form will be read, described, and signed. 
3. Research staﬀ will double check the inclusion and exclusion criteria, 
including whether the par.cipant has a working email address they 
would be willing to use to receive study communica.ons. 
Par.cipants will also be asked if they have a smartphone/tablet they 
are willing to use for the study and internet connec.on. 
4. Par.cipants will be asked about current journaling prac.ces, if any. 
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5. Par.cipants may also be placed on the wai.ng list if: a) they will not 
be at NUWAY for the dura.on of the study, b) research staﬀ is not 
sure if the person is eligible based on results of screening tests. In 
this case, NUWAY counseling staﬀ are consulted to make sure the 
par.cipant is eligible (e.g., if the person is adequately stabilized 
psychiatrically for par.cipa.on). 
6. Par.cipant will be asked to write a list of 5 things that happened 
yesterday, research staﬀ will evaluate this list and determine 
whether or not it is adequate for study inclusion. If not adequate, 
screening procedure will stop. 
7. Research staﬀ will administer the GAIN Cogni.ve Impairment 
Screener.57 This instrument uses 6 items to determine cogni.ve 
impairment. It uses ques.ons such as “What year is it now?” and 
“Please count backwards from 20 to 1.” Par.cipants earn points for 
correct answers. Cogni.ve impairment is considered to be present if 
the total score is greater than 10. If the par.cipant scores 14 or 
greater, they will be excluded from the study. Screening procedure 
will stop. 
Research staﬀ will ask par.cipants items derived from the GAIN SS 
instrument. The GAIN SS is a short instrument designed to 
determine whether individuals should be assessed more 
comprehensively for internalizing disorders (6 items), externalizing 
disorders (7 items), and criminal or violent behavior (5 items). The 
instrument also asks 5 items about substance use, but since all of 
the individuals in this study will have met criteria for a substance 
use disorder, we will not ask these ques.ons. The response format 
determines how recently the individual had the symptoms or the 
behavior. We will used a modiﬁed response format: 0=never, 1=in 
life.me, 2= last year, 3=last month, 4=last week. This response 
format has been revised from the original GAIN SS in order to 
capture whether any of the behaviors were more recent, that is, in 
the last 2 weeks versus the past 1-month. Knowledge of more 
recent behavior is needed to eﬀec.vely screen par.cipants for this 
study. We would change all the ques.ons and prompts that say 
“when was the last .me that you did the following things two or 
more .mes” to “when was the last .me that you did the following 
things” so that even one instance would count. We would modify 
any ques.on that asks about behavior at “school, work or home” so 
that it reads “school, work, home, or here at NUWAY.” We would 
add this phrase to the instruc.ons: “I will now ask you some 
ques.ons about your experiences. Please answer “as of today” so 
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“in the last week” would mean in the week that ends today. Please 
know I will not be asking you any follow up ques.ons for any of 
these next ques.ons. Depending on some of your answers, I might 
need to let NUWAY staﬀ know of your replies.” We would consider a 
high score to be two or more past-week symptoms for each 
subscale: internalizing disorder, externalizing disorder, or criminal/
violent behavior. Exclusion from the study based on these items 
would include endorsing “last week” for certain items such as: 
“thinking about ending your life or commi_ng suicide,” “lied or 
conned to get things you wanted or to avoid having to do 
something,” having a hard .me “paying a[en.on at school/work/
home” in combina.on with having a hard .me “listening to 
instruc.ons at school/work/home,” “were a bully or threatened 
other people,” “started physical ﬁghts with other people,” “had a 
disagreement in which you pushed, grabbed, or shoved someone,” 
and “purposely damaged or destroyed property that did not belong 
to you.”  In the event of high scores in any of the three subscales or 
a single score of “last week” for any of these selected items, the 
person would not be eligible for the study. However, in each of 
these cases, we would discuss the results with NUWAY staﬀ before 
determining ﬁnal eligibility for the study. 
8. The requirement of 2 weeks con.nuous sobriety before enrollment 
in the study may be waved based on clinical judgment.  
9. Par.cipant would read/review/discuss with study staﬀ the informed 
consent/HIPAA consent combined document. Par.cipant would 
read/review/discuss with study staﬀ the HIPAA consent document.  
10. Research staﬀ would ask the par.cipant the ques.ons from the 
UBACC quiz to determine capacity to consent.57 A score of 15 or 
higher is needed for inclusion in the study. The prospec.ve 
par.cipant can review the study details and return to re-do the quiz 
another day if this is possible given the study .meline.  
11. If they score over 15 on the UBACC and meet all other study 
inclusion/exclusion criteria, or if they are eligible for the wait list, 
they will they sign the main informed consent document 
(electronically if electronic administra.on). These forms will be 
signed in duplicate, providing one copy for research staﬀ and one 
for par.cipant (duplica.on unnecessary for electronic 
administra.on). 
12. If the par.cipant is deemed to meet all study criteria, they would 
move on to take the baseline assessment instrument.  
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13. Par.cipants will be asked to provide the names and contact 
numbers/email addresses for 2 people who will always know where 
they are. This informa.on will be collected via the screening check 
sheet (informa.on from the screening check sheet will now be 
administered via Redcap with data captured in Redcap rather than 
on paper) and will be used to help invite the par.cipant to the exit 
interview/follow up interview. At the end of the exit interview, 
par.cipants will be asked how best to reach them for the follow up 
interview 30 days later. Final Target gis cards will be disseminated 
electronically. (At the follow up interview, the control group will be 
mailed a copy of the journal and journal instruc.ons and so we will 
make sure to obtain their mailing address). 
14. Before randomiza.on, par.cipants will be asked, “In this study you 
will be assigned to either the Gold or Maroon groups. How do you 
feel about the fact that you would be helping us either by the Gold 
group ac.vi.es or the Maroon group ac.vi.es? How willing would 
you be to do your best whether you end up in the Gold or Maroon 
group? Are you willing to par.cipate even though you might not get 
the group of your ﬁrst choice? For our research it is important to get 
a good response rate. This means par.cipa.ng in study ac.vi.es as 
much as possible. Do you agree to help the project in this way?” 
Responses will be recorded on the screening check sheet. 
(informa.on from the screening check sheet will now be 
administered via Redcap with data captured in Redcap rather than 
on paper) 
15. If admi[ed into the study, par.cipants will be randomized into 
treatment and control groups. The treatment group is the “maroon” 
group the control group is the “gold” group (University of 
Minnesota school colors).  
16. If par.cipants decide not to par.cipate when they hear their group 
assignment, we will ask them why and record their answers on the 
screening check sheet. (informa.on from the screening check sheet 
will now be administered via Redcap with data captured in Redcap 
rather than on paper) 
17. Each group will receive instruc.ons for their arm of the study (See 
“instruc.ons for Maroon and Gold Groups v2,” a[ached.  
10.
Vulnerable Popula9ons 
10.1. Vulnerable Popula.ons:  
! Children  
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! Pregnant women/Fetuses/Neonates 
☒ Prisoners 
! Adults lacking capacity to consent and/or adults with diminished capacity 
to consent, including, but not limited to, those with acute medical 
condi.ons, psychiatric disorders, neurologic disorders, developmental 
disorders, and behavioral disorders 
! Approached for par.cipa.on in research during a stressful situa.on such 
as emergency room se_ng, childbirth (labor), etc. 
☒ Disadvantaged in the distribu.on of social goods and services such as 
income, housing, or healthcare 
! Serious health condi.on for which there are no sa.sfactory standard 
treatments 
! Fear of nega.ve consequences for not par.cipa.ng in the research (e.g. 
ins.tu.onaliza.on, deporta.on, disclosure of s.gma.zing behavior) 
! Any other circumstance/dynamic that could increase vulnerability to 
coercion or exploita.on that might inﬂuence consent to research or 
decision to con.nue in research 
☒ Undervalued or disenfranchised social group 
! Members of the military 
! Non-English speakers 
! Those unable to read (illiterate) 
! Employees of the researcher 
! Students of the researcher 
! None of the above 
10.2. Addi.onal Safeguards:  
Why we checked the “prisoner” box: 
Infrequently, NUWAY clients are furloughed from incarcera.on or workhouse. 
Some NUWAY clients are court mandated: they are civilly commi[ed. We would 
include both groups of individuals in this study. To ensure that such individuals 
are especially reassured that they are free to choose to be in the study or decline 
to be in the study without legal consequence, we added this language to the 
informed consent document: 
“We want to especially emphasize something for NUWAY clients who are 
furloughed from incarcera.on or workhouse or who are court mandated or civilly 
commi[ed. This study is op.onal and you can feel free to say no to this study and 
s.ll remain in treatment at NUWAY. Being in this study or not being in this study 
does not aﬀect your legal status in any way. Return to incarcera.on is in no way a 
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consequence of either deciding to be in the study or deciding not to be in the 
study. Please ask us if you have any ques.ons about this.”   
We also include special language in the informed consent document to clarify the 
consequences of certain kinds of disclosures to research staﬀ, including telling 
research staﬀ about substance use, intent to hurt someone else, and about 
crimes commi[ed. Here is the language we added, under the category, “What 
happens to the informa.on collected for the research?” 
“We will not ask you about child or vulnerable adult abuse. If you tell us about 
child or vulnerable adult abuse or neglect, we may have to report it to authori.es 
because of law or policy. This is true if you tell us in group, one on one mee.ngs, 
or in journal entries. Also, if we learn (in person or in any other contact you have 
with us) that you are at risk for hur.ng yourself or others, we will inform NUWAY 
treatment staﬀ of this informa.on as soon as possible.  
“In general, if something worries us about what you share with us in any way, we 
will let NUWAY staﬀ know. This includes any .me you tell us that you have used 
drugs or alcohol. Telling us that you have used drugs or alcohol will have the 
same consequences as if you told a NUWAY staﬀ member that you used drugs or 
alcohol. NUWAY staﬀ would work with you to make sure that you have the 
support you need to get back on track related to your recovery. 
“If you tell us that you commi[ed a crime, we would tell NUWAY Staﬀ. Telling us 
that you commi[ed a crime would have the same consequences as if you told a 
NUWAY staﬀ member that you commi[ed a crime. If you are on proba.on or 
parole, NUWAY staﬀ would need to report this to your proba.on or parole 
oﬃcer. 
“If you tell us that you intend to hurt yourself or someone else, we would tell 
NUWAY staﬀ. 
“Some of these things that you might tell us might have consequences related to 
your treatment status at NUWAY.  
“In general, the NUWAY Staﬀ will not ﬁnd out your answers to the iPad surveys.”  
11.
Number of Par9cipants 
11.1. Number of par.cipants to be consented will be approximately 100.  
12.
Recruitment Methods 
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12.1. Recruitment process. Recruitment will take place one of four ways. 1) 
NUWAY staﬀ will reach out to clients who appear to meet study criteria. 
Clients might receive the electronic or hard copy recruitment ﬂyer from 
their counselor.  Clients then will be encouraged to contact study staﬀ. 2) 
NUWAY staﬀ will complete a release of informa.on form with their clients 
allowing communica.on between NUWAY and the research team. NUWAY 
staﬀ will inform research staﬀ of client contact informa.on, and study staﬀ 
will reach out to clients (only if the release of informa.on has been signed, 
unless the counselor is facilita.ng an introduc.on based on the in-group 
recruitment presenta.on, see #3, for example, a counselor might provide 
contact informa.on for a client a[ending the recruitment presenta.on who 
needed assistance emailing or tex.ng us directy ). 3) Study staﬀ will make 
presenta.ons in NUWAY treatment groups (currently only to take place via 
Zoom), making the basic points from the recruitment ﬂyer (see recruitment 
PowerPoint, a[ached). Clients then will be encouraged to contact study 
staﬀ. 4) The recruitment ﬂyer might be posted on bulle.n boards or made 
available in group rooms or lounge areas on site (now that more clients are 
coming into the site in person) and clients can reach out to study staﬀ 
based on informa.on from the ﬂyer. 5) When clients are scheduled for a 
screening by research staﬀ, we will let the counselor know to begin the 
Release of Informa.on procedure and we will let the counselor know of the 
date and .me of the screening appointment. The purpose of this is to have 
the counselor help the client to follow through with a[ending the 
screening appointment (currently our rate of cancella.ons and no-shows 
for screenings is 51%) . Counselors, when helping with recruitment, will be 
advised by us that they must emphasize that par.cipa.on is en.rely 
op.onal and that clients may choose to par.cipate or not, and may drop 
out, cancel the screening appointment, reschedule the screening 
appointment, or con.nue with the study as they wish. Prospec.ve 
par.cipants’ rela.onships with NUWAY or the University of Minnesota will 
not be nega.vely compromised whatever choice they make, and this point 
will be emphasized.  
Interested clients will contact research study staﬀ by phone, email, or text. 
Whenever possible, study staﬀ will conduct a preliminary screening and if 
the par.cipant appears eligible, make an appointment for the screening 
interview. When a preliminary screening is not possible, the preliminary 
screening ques.ons will be the ﬁrst ques.ons asked at the screening 
interview. The preliminary screening ques.ons are designed to determine 
as quickly as possible when a person might be eligible for the study and will 
be conducted via a brief telephone call. The preliminary screening 
ques.ons are as follows: 1. Are you now a client at NUWAY? 2. How long 
have you been a client at NUWAY? (6 day minimum is required). 3. What is 
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your latest date of sobriety? (6 day minimum is required). 4. Are you at 
least 18 years old? 5. Who is your counselor and what NUWAY facility are 
you a[ending? 6. If you are part of this study, you might be asked to join a 
zoom group that meets from [insert .me of group, e.g., 12 to 1 pm] on 8 
weekdays, star.ng [insert start date]. Would that work for your schedule? 
7. If you are part of this study, we’ll be contac.ng you by email regularly. 
Would you be willing to check your email daily? 8. How is your ability to 
read and write in English? 9. Do you have a device (smartphone/tablet) that 
has a camera in it, and can connect to the internet? Would you be willing to 
use this device for the research study? 10. Are you able to a[end Zoom 
mee.ngs for the research study? 11. Are you able to ﬁll out electronic 
ques.onnaires that we will send to you? 12. What ques.ons can we answer 
about the research study? 
At the screening interview, research staﬀ will guide prospec.ve par.cipants 
through the screening informed consent, regular informed consent 
procedure, take the baseline ques.onnaire, and be randomized into the 
treatment (maroon) or control (gold) groups. Individuals who meet criteria 
for the wai.ng list would also have the opportunity to take the baseline 
screening instrument. 
12.2. Source of Par.cipants: All par.cipants to be enrolled in the study will be 
concurrently receiving SUD treatment at NUWAY Inc. Study par.cipa.on is 
oﬀered in addi.on to SUD treatment as usual, but par.cipants may miss 
NUWAY groups in order to instead a[end PPJ groups. This decision will be 
made by NUWAY staﬀ. During COVID19, our groups will be oﬀered at .mes 
other than NUWAY core remote treatment groups whenever possible. 
12.3. Iden.ﬁca.on of Poten.al Par.cipants: See 12.1, above.  
12.4. Recruitment Materials: Recruitment materials include the recruitment ﬂyer, 
recruitment PowerPoint (if a presenta.on is made in client treatment 
groups), screening informed consent, and regular informed consent 
documents (copies are a[ached).   
12.5. Payment to research par.cipants: Payment will be made in the form of 
Target gis cards given out electronically. Target gis cards cannot be 
replaced if lost or stolen, this is stated on the regular consent form. Values 
of the Target gis cards will be based on par.cipa.on as follows: 
Par.cipants will be compensated $15 for the baseline assessment 
instrument and $5 for a[ending each group session during the 3-week 
Group Phase (treatment group) or for comple.ng 8 Qualtrics surveys 
(control group). Par.cipants will be compensated $5 each .me they upload 
PPJ using Qualtrics in addi.on to the 8 group opportuni.es.  
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During the two-week Independent Prac.ce Phase, par.cipants are required 
to upload PPJ a minimum of 3 .mes per week but can upload a maximum 
of 7 .mes per week if they wish to but they will only be compensated up to 
5 .mes (treatment group). During this same period, the control group will 
have equivalent opportuni.es to complete Qualtrics surveys. Each .me 
they upload, they will be compensated $5, assuming all aspects are 
completed (successful upload of photograph (for treatment group only) and 
answering study ques.onnaire items). Par.cipants can feel free to upload 
more than 5 .mes a week (maximum would be daily) but would not be 
compensated for more than 5 .mes per week. Par.cipants are not 
compensated addi.onally for uploads that take place during group sessions 
(treatment group individuals will already be compensated for a[ending 
group). 
Par.cipants will be compensated $10 for the exit interview and $10 for the 
30 day follow up interview. Par.cipants will be paid a $20 bonus for 
comple.ng the baseline interview, the exit interview, follow up interview, 
and at least 90% of all other study ac.vi.es (group par.cipa.on, 
homework, and the minimum number of independent PPJ uploads). 
Total possible compensa.on including the bonus is $160. 
Payment to addic.on treatment providers/administrators: We will oﬀer $40 
in gis cards to treatment providers / administrators for reading, cri.quing, 
and oﬀering edits and comments to our dras PPJ treatment manual. 
13.
Withdrawal of Par9cipants 
13.1. Withdrawal Circumstances: Par.cipants will be withdrawn from the 
research without their consent for three reasons: 1) if the par.cipant leaves 
NUWAY treatment against staﬀ advice, 2) if the par.cipant leaves NUWAY 
treatment at the request of staﬀ for breaking the rules (for example, if they 
ins.gate a physical alterca.on), or 3) the par.cipant leaves NUWAY 
treatment without discussion with staﬀ and does not return. In these three 
situa.ons, we would retain the person’s data to date and code them has 
having discon.nued treatment, since treatment reten.on is one of our 
primary outcomes. Par.cipants of course can keep any Target gis card 
credits they have earned. If a par.cipant leaves treatment and the study 
owes the individual Target gis cards, these will be distributed electronically. 
13.2. Withdrawal Procedures: Par.cipants can elect to leave the study at any 
.me. This is emphasized in the informed consent document. If par.cipants 
leave the study, we will s.ll consult NUWAY records to determine relapse or 
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treatment departure for all study par.cipants. We will include this 
informa.on in the informed consent document. 
Termina.on Procedures: If a par.cipant stops par.cipa.ng in study 
ac.vi.es, we will reach out to them up to 2 .mes and ask them if they 
would like to leave the study. If they say no then the process will stop and 
we will pay them any Target gis cards we owe them. If they are uncertain, 
we will warmly invite them to return to study ac.vi.es, but will then 
consider them to have les the study if they do not return. We may also ask 
NUWAY staﬀ to help us ﬁnd out this informa.on. If a person wishes to leave 
the study, we will note this in our study records. For individuals who leave 
the study prematurely, we will use data already collected and follow up 
data on relapse and treatment departure in our data analyses. Par.cipants 
of course can keep any Target gis card credits they have earned and we will 
pay out any addi.onal Target gis cards earned upon their exit from the 
study.  
NUWAY study par.cipants will be required to sign a release of informa.on 
naming research staﬀ, so that research staﬀ and NUWAY staﬀ can 
communicate with each other. If study par.cipants call research staﬀ by 
telephone, we will be able to call them back at NUWAY and speak to them 
or leave a message. 
14.
Risks to Par9cipants 
14.1. Foreseeable Risks: The poten.al risks in this study include those related to 
conﬁden.ality, alcohol and illicit drug abs.nence, and uncomfortable 
emo.ons when comple.ng PPJ and Qualtrics ques.onnaires, which will ask 
about substance use, aﬀect, trauma history, sa.sfac.on with recovery, and 
other wellbeing and health indicators.  
Although the PPJ is hypothesized to be suppor.ve, aﬃrming, and 
encouraging, uncomfortable emo.ons may also arise when looking back 
over the past 24 hours or planning the upcoming 24 hours when 
comple.ng PPJ.  
One risk to conﬁden.ality will be if a third party (such as another person 
residing with them ) reads the par.cipant’s journal. We will advise 
par.cipants to use codenames and symbols to code material that is 
especially private to them in case their journal is viewed by other people. 
We will also advise par.cipants to keep journals stored in a safe place. 
Some par.cipants may accidentally take a picture of their journals outside 
of the Qualtrics survey which would then be saved on their phone or tablet 
unless deleted. This is described as a risk on the informed consent 
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document. We will ask par.cipants to make sure they are in a quiet, private 
place when they are on any Zoom calls with us and are encouraged to use 
headphones to reduce risk that anyone will overhear what is being 
discussed. 
Although our sample par.cipants will have been in treatment for a 
minimum of one week at NUWAY and should no longer be experiencing the 
acute physical withdrawal eﬀects associated with drug and alcohol 
abs.nence, con.nued abs.nence from drugs and alcohol is osen 
associated with irritability, restlessness, anxiety, depressed mood, sleep 
disturbance, increased appe.te, and decreased concentra.on. Abs.nence 
may also exacerbate pre-exis.ng mental health condi.ons. Although these 
symptoms may be eﬀec.vely treated with appropriate interven.on, we will 
monitor these symptoms at each session.  
Individuals repor.ng extreme mental health issues either in the treatment 
group or in their PPJ Qualtrics entries will be referred to NUWAY staﬀ. In 
such cases, we will refer the pa.ent to appropriate medical/psychiatric/
counseling staﬀ at the NUWAY. More speciﬁcally, individuals who indicate 
suicidal idea.on will be referred to the NUWAY staﬀ. NUWAY staﬀ would 
then follow their usual procedures and refer pa.ents with life threatening 
condi.ons to inpa.ent psychiatric programs in the Minneapolis metro area.  
Procedures to be performed to lessen the probability, magnitude, 
dura9on, or reversibility of those risks. All of the informa.on obtained 
from subjects is en.rely for research purposes and will be referenced by 
codename or number versus par.cipant name and kept in locked 
conﬁden.al ﬁles at the University of Minnesota School of Social Work or on 
password protected University of Minnesota computers or servers. At 
baseline, par.cipants will be invited to select a codename or number that 
they can easily remember but one that is not an iden.ﬁer (e.g., real name, 
birthdate). They will use this codename or number on all study materials 
except for the informed consent document including study homework and 
PPJ entries. Their codename and real name are also listed on paper forms 
but these are always kept in a locked ﬁle cabinet or locked ﬁle box. 
The original PPJ entries will remain in the hard-copy paper journal which we 
will provide to par.cipants. The research team will see electronic snapshots 
of journal entries uploaded to Qualtrics. These snapshots will not contain 
iden.fying informa.on (par.cipant name, date of birth, etc.). It is 
important to see these snapshots to make sure the par.cipant is 
authen.cally comple.ng PPJ that day. 
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Consent forms will be collected and saved securely using REDCap. All data 
collected via Qualtrics are solely iden.ﬁed by codename or number and are 
not iden.ﬁable by any other subject informa.on. The exit interviews and 
parts of group sessions will be transcribed. Transcrip.ons will be fully de-
iden.ﬁed.  
We will maintain an electronic document with a password that links subject 
number or codename to par.cipant names, and we will delete this 
document aser data analyses are complete, approximately one year aser 
the last data are collected from study par.cipants. We will also destroy any 
paper forms linking real name to codename at this same .me. 
There may be some discomfort associated with comple.ng ques.onnaires 
that ask about aﬀect, which may be poor in early recovery, sa.sfac.on with 
life in recovery, which may be low in early recovery, and history of 
substance use and trauma. There may be some discomfort with looking 
back over the past 24 hours and planning the upcoming 24 hours. We 
expect that any such discomfort would be temporary. We will alert 
par.cipants to this in the informed consent document and in group. We 
will also address emo.ons related to past 24 hour review and planning the 
upcoming 24 hours to provide support and understanding for any 
uncomfortable feelings that may arise during the group sessions. Any 
emo.ons of extreme intensity or dura.on will cause study staﬀ to refer the 
par.cipant to NUWAY staﬀ.  
A NUWAY staﬀ member may or may not sit in on group sessions to monitor 
the session and par.cipant wellbeing, as the groups will be part of 
par.cipants’ overall NUWAY experience (having a staﬀ member sit in on 
groups has been less necessary during remote delivery). If an individual is in 
an amount of distress that cannot be managed by the group process, then 
the NUWAY staﬀ member can take the person out of group to address the 
issue. The NUWAY staﬀ member will also help maintain group norms, group 
rules, and appropriate group behavior which will foster an environment 
conducive to learning. If there should be a group mee.ng conducted 
without a NUWAY staﬀ member for any reason, and any incident of this 
kind takes place, research study staﬀ will go down the hall to ﬁnd a NUWAY 
staﬀ member to assist. During electronic administra.on, we would excuse 
the NUWAY par.cipant from the group and contact NUWAY staﬀ or 911 
immediately in the case of a medical emergency. 
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Another risk is the privacy of journal contents. The journaling prac.ce is 
meant to capture the person’s lived experience over the past 24 hours. 
Some of this content will be private and personal and not meant to be 
shared with anyone, which is en.rely acceptable and even encouraged. 
However, to keep such informa.on private in a wri[en journal, we will 
encourage par.cipants to use code names or code ini.als for very personal 
informa.on, e.g., “I was upset and mad at DB” where DB are code ini.als 
for the individual referenced. This will protect the individual in case a third 
party (e.g., other NUWAY resident) reads the person’s journal. We will ask 
all par.cipants to respect the privacy of other people’s journals. We will 
discuss this in the group sessions.  
We will monitor journal entries submi[ed in the Group and Independent 
Prac.ce Phases for any informa.on about feelings about par.cipants 
hur.ng themselves or others or cases of abuse of a vulnerable adult or 
child neglect or abuse. We are mandated reporters in such cases and will 
share what we see with NUWAY staﬀ and make sure that repor.ng 
procedures are followed. NUWAY will provide us with an emergency staﬀ 
number that we can dial 24/7 if we see something worrisome in a PPJ 
journal entry uploaded to Qualtrics. We will describe this limita.on to 
conﬁden.ality in the informed consent document and in group sessions.  
14.2. Reproduc.on Risks: N/A 
14.3. Risks to Others: One group exercise we will employ is “each one teach one.” 
In this exercise, group members are invited to choose someone in their 
suppor.ve network to teach the journaling prac.ce to. This secondary 
person would be invited by the par.cipant to try PPJ, and then the 
“teacher” and the friend will share contents of PPJ with each other. We do 
not expect that the secondary par.cipant would face any risks beyond mild 
and temporary feelings of discomfort that might arise when reviewing the 
past 24 hours or planning the upcoming 24 hours.  
15.
Incomplete Disclosure or Decep9on 
15.1. Incomplete Disclosure or Decep.on: N/A. Par.cipants will be informed that 
this is a study of journaling in recovery. 
16.
Poten9al Beneﬁts to Par9cipants 
16.1. Poten.al Beneﬁts: The hypothesized beneﬁt of the proposed study is the 
poten.al of improving sa.sfac.on with life in recovery and increasing other 
wellbeing factors (e.g., posi.ve emo.on), which we hypothesize will 
support sustained abs.nence from alcohol and other illicit drugs and 
sustained enrollment in the NUWAY treatment center. However, while there 
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is evidence that gra.tude prac.ces and ac.vity planning may yield such 
beneﬁts, there is no evidence for the beneﬁts of the combined elements 
that comprise PPJ. The control group will receive the journal and brief 
instruc.ons for using it and access to the YouTube videos that describe how 
to use the journals at the exit interview and therefore they may experience 
some of these beneﬁts. However, in our previous research, par.cipants told 
us that they felt that the comple.on of the PANAS instrument to assess 
mood felt therapeu.c.60 
Although poten.al risks include frustra.on, exis.ng psychological 
withdrawal eﬀects from alcohol and substance use abs.nence, mild 
discomfort when ﬁlling out ques.onnaires, and adjus.ng to a new lifestyle, 
these are not life threatening and will subside as treatment progresses.  
Finally, issues of conﬁden.ality are a high priority and will be closely 
monitored throughout the treatment study. Consequently, the risk to 
beneﬁt ra.o in the proposed study appears to be acceptable. 
17.
Data Management 
17.1. Data Analysis Plan: Please see “Analysis Plan” under 5.2, above.  
17.2. Power Analysis: Preliminary data from exis.ng behavioral ac.va.on 
(BA) research was used to determine power for the original 
proposal with N=76. For the outcome of abs.nence (yes/no), 
previous work found outcomes for this variable of 41.5% for the BA 
group and 24.8% in the control group.14 For a 1-tailed test with 
p<.10, our power to detect a signiﬁcant eﬀect for abs.nence (yes/
no) in the proposed study would be .61 (for a 2-tailed test with 
p<.05, power would be .34). For the outcome of treatment 
reten.on (yes/no), previous work showed 96.6% for the BA group 
and 75.9% in the control group.16 For a 1-tailed test with p<.10, our 
power to detect a signiﬁcant eﬀect for treatment reten.on (yes/no) 
in the current study would be 94% (for a 2-tailed test with p<.05, 
power would be .82). Therefore, we should be adequately powered 
to detect sta.s.cally signiﬁcant diﬀerences for the outcome of 
treatment reten.on in the current study using a 2-tailed test. R was 
used to conduct these power analyses.61 
17.3. Sta.s.cal Analysis: This pilot study will not be adequately powered to 
detect an eﬀect. S.ll we will compare the treatment and control groups 
using t tests and mul.-level models to determine diﬀerences in means and 
in slopes between the groups, respec.vely. Descrip.ve sta.s.cs of the 
quan.ta.ve measures will be used to conduct power analyses and sample 
size calcula.ons for a larger controlled trial. Also, mul.-level analyses will 
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be conducted to determine signiﬁcant change over .me in factors of 
interest. We will also be able to examine whether change over .me varied 
by certain subgroups (e.g., those with lower versus higher levels of the 
factor of interest at baseline). 
17.4. Data Integrity: The use of Qualtrics to collect survey data will improve data 
accuracy because this allows us to avoid keystroke and other errors 
involved with manual data entry from wri[en ques.onnaires. We will 
scru.nize the data produced by Qualtrics to ensure its integrity; whether 
values are within scale ranges and whether missing data is coded correctly. 
We will carefully examine and clean the data to ensure accuracy. For 
standardized instruments, we will be very careful to follow the direc.ons 
for summing or taking the mean of scale items and reverse code any items 
as per the instruc.ons. 
18.
Conﬁden9ality 
18.1. Data Security: We will safeguard against breaches of conﬁden.ality by 
coding par.cipant data by codename or number rather than by name and 
by keeping informa.on linking these codenames or numbers to research 
staﬀ via password protected electronic ﬁle. Further, no individuals will be 
iden.ﬁed by name nor will any iden.fying informa.on be oﬀered when 
presen.ng data in lectures, seminars, professional presenta.ons, or papers. 
When qualita.ve data are transcribed, whether from exit interviews or 
recorded group sessions, they will be de-iden.ﬁed to replace any spoken 
names or iden.ﬁers with brackets, e.g., “Joan” will be replaced with 
“[Par.cipant’s Daughter].” 
The Oﬃce of Measurement Services (OMS) of the University of Minnesota 
will be assis.ng the study by designing the Qualtrics mechanism that we 
will use for data collec.on. OMS has many years of experience in collec.ng, 
maintaining, and storing data in accordance with FERPA and HIPAA 
regula.ons. OMS’s internal security and safeguards go beyond the 
minimum levels established for the University of Minnesota. OMS provides 
data security and privacy protec.on by using a dedicated server to store 
data, by performing daily data back-ups, and by using Secure Sockets Layer 
(SSL), the industry-standard means for safeguarding web communica.ons. 
OMS also u.lizes encryp.on protocols for the storage and transmission of 
data which further ensures data security. Addi.onally, OMS recently 
completed IT risk assessments from Berry Dunn and Deloi[e to verify that 
our data handling and storage procedures are up to date and eﬀec.ve. 
NUWAY will make men.on in chart notes if and when clients have 
par.cipated in PPJ groups.  
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Since this research is being funded by the Na.onal Ins.tutes of Health, it is 
automa.cally issued a Cer.ﬁcates of Conﬁden.ality (CoC). The CoC 
protects the privacy of research par.cipants by prohibi.ng disclosure of 
iden.ﬁable, sensi.ve research informa.on to anyone not connected to the 
research except when the par.cipant consents or in the following 
situa.ons: (1) The Cer.ﬁcate cannot be used to resist a demand for 
informa.on from personnel of the United States Government that is used 
for audi.ng or evalua.on of Federally funded projects or for informa.on 
that must be disclosed in order to meet the requirements of the Federal 
Food and Drug Administra.on (FDA). (2) The Cer.ﬁcate of Conﬁden.ality 
will not be used to prevent disclosure to state or local authori.es of child 
abuse and neglect, or harm to self or others. 
19.
Provisions to Monitor the Data to Ensure the Safety of Par9cipants 
19.1. Data Integrity Monitoring:  
The job of data integrity monitoring will be conducted by PI Krentzman. She 
will oversee all study progress and ensure that the study is conducted, 
recorded, and reported in accordance with the protocol and standard 
opera.ng procedures. In the event that changes to the protocol are 
needed, PI Krentzman will make modiﬁca.ons using standard IRB 
procedures. PI Krentzman is an Associate Professor of Social Work and has 
been employed by the University of Minnesota since 2013. PI Krentzman 
has exper.se in posi.ve psychology,62,63 gra.tude,17,22 and spirituality in 
AUD recovery;64–67 as well as qualita.ve data analysis;17,60 quan.ta.ve data 
analysis;64,65,68 mechanisms of behavior change;64 and the conduct of 
randomized control trials to test novel interven.ons to support AUD 
recovery.17,69 PI Krentzman will be in ongoing contact with staﬀ at NUWAY, 
speciﬁcally Ken Roberts, Chief Clinical Oﬃcer of NUWAY, and the NUWAY 
site supervisor, who will be the study’s primary contacts at the host agency. 
PI Krentzman will supervise study staﬀ including all Research Assistants. 
Supervision will involve face to face mee.ngs at a minimum of once every 
two weeks. Study reports will be provided to the IRB according to the 
regularly scheduled requirements of such repor.ng. In these reports we 
will describe recruitment progress and study ﬁndings as they unfold. 
19.2. Data Safety Monitoring:  
All research staﬀ will complete the online training modules which cover HIPAA, 
ethical research with human subjects, accuracy, record keeping, and 
conﬁden.ality. These modules are oﬀered by the University of Minnesota 
and include HIPAA Training and the Collabora.ve Ins.tu.onal Training 
Ini.a.ve (CITI) Program’s Social/Behavioral or Humanist Research 
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Inves.gators and Key Personnel curriculum. PI Krentzman will model and 
extensively review this content with all staﬀ. 
Safety. 
As noted in the human subjects sec.on of this applica.on, we will protect 
against physical and emo.onal symptoms resul.ng from substance use 
abs.nence and any other relevant psychological symptoms. Further, we are 
acutely aware of the importance of protec.ng par.cipant conﬁden.ality 
and in abiding by HIPAA guidelines.  
The baseline session will take place in a private and quiet se_ng at NUWAY, or, 
with electronic administra.on, on a Zoom call but we will make sure the 
par.cipant is in a quiet, private place and will encourage them to use 
headphones. The mee.ng will begin with screening informed consent, 
screening, and then informed consent, which will include a detailed 
descrip.on of the purpose and procedure of the study, emphasizing our 
policy regarding privacy and conﬁden.ality, and an opportunity for the 
individual to ask any ques.ons or voice any concerns. A screening informed 
consent document will be signed before screening ac.vi.es take place. A 
regular informed consent document will be reviewed and a quiz on its 
contents passed before any study data are collected. Documents will be 
signed electronically. We will invite and answer any ques.ons about the 
study. We will make sure the par.cipant understands the informa.on and 
does not feel pressured to make a decision. Par.cipants will understand 
that their par.cipa.on is en.rely voluntary. 
Aside from signing the consent forms, and the “codename” form, The 
par.cipants’ name will be retained in REDCap but all other data (from the 
Qualtrics surveys for example) will be separated from the par.cipant’s 
name; only research staﬀ will have access to a document(s) that links 
par.cipant number/codename and name. All of the informa.on obtained 
from subjects is en.rely for research purposes and quoted by codename or 
number and kept in locked conﬁden.al ﬁles at our oﬃces at the University 
of Minnesota or on password protected laptops or university servers. This 
informa.on is not available to anyone except the inves.gators. 
Although our sample par.cipants will have been in treatment a minimum of 2 
weeks and no longer suﬀering from the acute physical withdrawal eﬀects of 
alcohol or drug abs.nence, con.nued abs.nence from drugs and alcohol is 
osen associated with irritability, restlessness, anxiety, depressed mood, 
sleep disturbance, increased appe.te, and decreased concentra.on. 
Abs.nence also may exacerbate pre-exis.ng condi.ons. Although these 
symptoms may be eﬀec.vely treated with appropriate interven.on, we will 
monitor these symptoms at each session. Individuals repor.ng moderate or 
persistent concerns or problems will be referred by study staﬀ to 
appropriate medical/psychiatric staﬀ at NUWAY. We will periodically 
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evaluate the data collected regarding both harms and beneﬁts to 
determine whether par.cipants remain safe.  
Study Research Assistants or PI Krentzman will review the data, especially the 
pictures of the journal entries, as soon as possible aser submission but no 
later than 72 hours aser submission to examine the data for any safety 
concerns.  
If par.cipants experience distress related to the baseline ques.onnaire, 
including the ques.on that asks about history of trauma, we will refer them 
to NUWAY staﬀ.  
We will use the Zoom wai.ng room feature and we will only admit group 
members into the Zoom room. If a group member behaves inappropriately 
(e.g., shares inappropriate words or images, i.e., Zoom bombing) we will 
remove them from the Zoom room. 
20.
Provisions to Protect the Privacy Interests of Par9cipants 
20.1. Protec.ng Privacy: REDCap informa.on will contain the par.cipant’s name 
but all other documents in paper or electronic format will include the 
person’s codename or number only. An electronic ﬁle matching par.cipant 
name to codename or number will be kept on a password protected 
computers and the ﬁle itself will be password protected and erased one 
year aser the conclusion of data analysis. Any paper copies of this 
informa.on will also be destroyed at this .me. 
We will go to great lengths to make sure par.cipants understand the nature 
of the research study and our concern about their privacy. This will be 
made clear in the content of the informed consent document. We will 
review this informa.on with par.cipants in depth as we go over all 
elements of the informed consent process. We will assure the par.cipant 
that we will do everything we can to ensure their privacy, including using a 
codename or number associated with their data and pu_ng a password on 
the electronic ﬁle that matches their codename or number to their name. 
Limita.ons to conﬁden.ality will also be described, such as whether the 
par.cipant describes the desire to harm themselves or others, or whether a 
minor or vulnerable adult is at risk of abuse or neglect. We will ask that 
par.cipants use a quiet, private room for Zoom mee.ngs and use 
headphones if at all possible during our Zoom class with them. 
20.2. Access to Par.cipants: The research team will not have access to NUWAY 
records. To determine our key outcomes, recurrence of substance use or 
discon.nua.on of treatment, a NUWAY staﬀ member will meet with a 
member of the research team at reasonable .me intervals to share 
whether par.cipants have les treatment or whether they have resumed 
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substance use. Resump.on of substance use is conﬁrmed at NUWAY via 
urine tes.ng or other drug screening or client self-report. Results of these 
tests, if posi.ve for substances, will be communicated to research staﬀ at 
reasonable periods and we will code this informa.on into our de-iden.ﬁed 
data records. We will also have staﬀ check the NUWAY record if the 
individual does not remember the date they started at NUWAY. 
21.
Compensa9on for Research-Related Injury 
21.1. Compensa.on for Research-Related Injury: N/A 
21.2. Contract Language: N/A 
22.
Consent Process 
22.1. Consent Process (when consent will be obtained): Our consent process is 
informed by the instruc.ons provided in HRP-090 and HRP-091. The 
consent process will take place on site at NUWAY (for electronic 
administra.on, it will take place via Zoom). Research staﬀ will meet with 
prospec.ve par.cipants. First, par.cipants will complete a screening 
informed consent document then they will be screened using our screening 
document (a[ached to ETHOS). If the par.cipant meets eligibility, we will 
oﬀer the par.cipant the choice of reading the informed consent document 
and we will verbally summarize it for them in detail. Par.cipants will be 
administered the UBACC quiz to determine that they have understood the 
study and their role in the study. A score of 15 or higher is needed for 
inclusion in the study. An impar.al witness will be used if necessary, for 
example, if the prospec.ve par.cipant has a visual impairment and cannot 
read the informed consent document. If an impar.al witness is used we will 
follow the guidelines described in HRP-090 for that procedure. 
22.2. Waiver or Altera.on of Consent Process (when consent will not be 
obtained, required informa.on will not be disclosed, or the research 
involves decep.on): N/A 
22.3. Non-English Speaking Par.cipants: N/A 
22.4. Par.cipants Who Are Not Yet Adults (infants, children, teenagers under 18 
years of age): N/A 
22.5. Cogni.vely Impaired Adults, or adults with ﬂuctua.ng or diminished 
capacity to consent: N/A 
22.6. Adults Unable to Consent:  
●
Permission: N/A 
●
Assent: N/A  
23.
Sehng 
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23.1 Research Site: NUWAY House, Inc. NUWAY is the host partner for the 
proposed study. NUWAY is a private, not-for-proﬁt substance-use disorder 
treatment facility serving men and women with addic.ons since 1966. 
NUWAY operates ﬁve treatment centers which serve over 700 clients in the 
Twin Ci.es. The proposed work will recruit from NUWAY’s 3R’s Counseling 
Center, 1404 Central Avenue NE, Minneapolis, MN which currently serves 
288 intensive outpa.ent clients for individualized treatment dura.ons 
generally ranging from 90-120 days. This is a 17,000 square foot facility 
featuring 13 group rooms, 21 oﬃces assigned to counseling staﬀ, eight 
therapy oﬃces with standard oﬃce furniture that are open to any staﬀ 
member or clinician for client interviewing (which we have been permi[ed 
to use to screen and consent clients), several client lounges, a cafeteria for 
clients, a lecture hall that seats 150 people, a smoking area, and an outdoor 
green space. There is high-speed wireless internet throughout the facility 
that can be accessed by research staﬀ and clients to upload their journals 
and complete daily assessments. 3R’s has 18 full-.me licensed clinicians, 
two program managers, one program director, four admissions staﬀ, 14 
interns from various counseling programs throughout the Twin Ci.es, and 7 
ﬂoa.ng therapists who ﬁll in as needed. Clients at 3R’s receive 20 hours of 
licensed substance-use disorder treatment per week, 4 hours per day, 
Monday through Friday. Treatment elements include educa.onal lectures, 
process group therapy, and individual therapy. PPJ is not redundant with 
current services oﬀered. The facility is 4.5 miles from the PI’s oﬃce at the 
School of Social Work, a 13 minute drive. During COVID19, NUWAY staﬀ are 
providing groups and individual sessions to clients on Zoom. 
As of August 2020, we will also be recrui.ng from a second NUWAY site, 
“NUWAY III.” NUWAY III is located at 2104 Stevens Avenue South, 
Minneapolis, MN 55404. NUWAY III is a medium-intensity residen.al 
treatment program for women and transgender people. The program 
provides comprehensive treatment for substance use and mental health 
disorders and has the capacity for 31 women and transgender people. 
NUWAY III oﬀers gender-informed curriculum, treats trauma, and oﬀers 
individual and group therapy. 
As of September 2020, we will also be recrui.ng from a third NUWAY site, 
“2118.” Nuway’s 2118 Blaisdell Avenue South loca.on in Minneapolis, MN, 
serves over 220 outpa.ents each year. Nuway is an extended care 
outpa.ent facility where clients a[end treatment 4 hours per day, Monday 
through Friday, for 90-120 days. “2118” is a 20,000 square foot facility 
featuring 10 group rooms, 16 oﬃces assigned to counseling staﬀ, ﬁve 
therapy oﬃces, several client lounges including ﬁve designated as quiet 
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areas, a cafeteria for clients, a lecture hall that seats 135 people, a smoking 
area, and an outdoor green space. “2118” has 15 full-.me licensed 
clinicians, two clinical supervisors, one program director, one execu.ve 
program director, three admissions staﬀ, three informa.on technology 
support staﬀ, 6-10 interns from various counseling programs throughout 
the Twin Ci.es, and 2-4 ﬂoa.ng therapists who ﬁll in as needed. 
All study procedures are the same for all NUWAY sites.  
  
2.
Interna.onal Research: N/A 
3.
Community Based Par.cipatory Research: N/A 
2.
Mul9-Site Research  
N/A 
3.
Resources Available 
3.2. Resources Available:  
Time. The Agricultural Experiment Sta.on (AES) grant that is funding this 
study provides PI Krentzman with one course buy out for the academic year 
2019-2020. PI Krentzman will use this .me and addi.onal .me to 
conduc.ng and comple.ng this research.  
Research Assistant(s) (RA). The AES grant that is funding this study allows 
for two 25% RAs for the 2019-2020 school year and two 25% RAs for the 
2020-2022 school year. One RA will be dedicated to this study. The CTSI 
grant will also provide a second RA. The RAs will be involved in all aspects 
of the research including screening and informed consent, data 
management, data cleaning, literature reviews, exit interviews, a[ending 
group sessions, and general research ac.vi.es. 
Facili9es. The School of Social Work is home to ﬁve research and training 
centers that serve local and na.onal educators, researchers, and 
professional social workers. The School is located at 1404 Gortner Avenue 
in St. Paul, MN. Faculty members at the School of Social Work are among 
the most produc.ve in the na.on, conduc.ng research on a wide range of 
topics. The School produces a wide range of high-quality research relevant 
to social welfare including work in health, mental health, disability, aging, 
and methods and methodology (h[p://www.cehd.umn.edu/ssw). The 
School of Social Work’s research commi[ee hosts monthly research 
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colloquia to showcase the current research of University of Minnesota 
faculty.  
Oﬃces. A 118 square foot oﬃce for PI Krentzman is permanently available 
in Peters Hall. The oﬃce features a desk, credenza, a[ached table with two 
guest chairs, two lockable large two-drawer ﬁling cabinets, one lockable 
three-drawer ﬁling cabinet, and high-speed internet access hardwired to a 
laptop docking sta.on. The University’s wireless network is also accessible 
throughout Peters Hall. Project staﬀ will be equipped with addi.onal oﬃce 
space in Peters Hall similarly equipped with desks, chairs, ﬁling cabinets, 
computers, and internet service. During COVID19 Dr. Krentzman is working 
remotely. 
Computers. The PI has a Dell PC laptop (Windows 10) and two monitors. All 
research staﬀ will have Dell PC worksta.ons in their oﬃces. The University 
provides SPSS Sta.s.cs Sosware and the PI has perpetual licenses for two 
copies of NVivo sosware for qualita.ve data analysis. Annual NVivo 
licenses have been purchased for addi.onal research staﬀ members. 
Availability of medical or psychological resources. These currently exist at 
NUWAY and will be u.lized if necessary via referral of the par.cipant to 
NUWAY staﬀ in the event of medical or psychological concerns beyond the 
scope of this study. 
Trained research staﬀ. PI Krentzman takes responsibility to ensure that all 
persons assis.ng with the research are adequately informed about the 
protocol, the research procedures, and their du.es and func.ons. Research 
assistants will be trained in data collec.on, data cleaning, and data 
management including recruitment ac.vi.es, informed consent, and 
administra.on of self-report, interview, and electronic measures. All 
research staﬀ will complete University of Minnesota training modules 
which cover HIPAA, ethical research with human subjects, accuracy, record 
keeping, and conﬁden.ality. PI Krentzman will model and extensively 
review this content with staﬀ. Research assistants will develop skills (e.g., 
informed consent procedures) via role-play exercises with PI. Krentzman. PI 
Krentzman will provide ongoing supervision for research staﬀ. 
4.
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