Guanfacine for Alcohol Use Disorder (AUD) Study Interest Form

We are offering a 12 week Research Study opportunity for people between the ages of 18-55 that are struggling with Alcohol Use Disorder.

Help us study a medication called Guanfacine to reduce Alcohol cravings. This research study is primarily remote with 4 in-person sessions.

We are offering compensation of approximately $1,300.

Visit the Study website for more information.

Please fill out the form below and we will get back to you as soon as possible to schedule an initial phone screen. All information you provide is confidential.

Full Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you between the ages of 18 and 55?*

YesNo

What is your gender?

FemaleMaleOther

Are you a heavy drinker?*

YesNo

Are you willing to NOT drink for 5 days of the study? *

YesNo

Preferred DAY to contact you (Please select all that apply)

Preferred TIME to contact you (Please select all that apply)

What is your preferred method of contact? (Please select all that apply)

EmailPhone CallText