A preliminary randomized controlled trial of contingency management for alcohol use reduction using a transdermal alcohol sensor

AIMS We tested the efficacy of daily contingent reinforcement for reducing alcohol use compared with (yoked) non-contingent reinforcement (NR) using a transdermal alcohol sensor to detect alcohol use. DESIGN Pilot randomized controlled design with 1 baseline week, 3 intervention weeks and 1-month follow-up. SETTING New England, USA. PARTICIPANTS Heavy drinking adults (46.7% female) not seeking treatment were randomized to (1) an escalating schedule of cash reinforcement (CR; n = 15) for days on which alcohol was neither reported nor detected or (2) yoked NR (n = 15). INTERVENTION AND COMPARATOR Reinforcement for CR participants started at $5 and increased $2 every subsequent day on which alcohol was not detected or reported, to a maximum of $17. Participants received no reinforcement for days on which alcohol use was detected or reported, and the reinforcer value was re-set to $5 the day after a drinking day. NR participants were yoked to the daily reinforcer value of an individual in the CR condition, in order of enrollment. Paired participants in CR and NR therefore received the same amount of money, but the amount for the NR participant was not behavior-related. MEASUREMENTS The primary outcome was percentage of days without sensor-detected drinking. Secondary outcomes were number of consecutive days with no detected drinking, peak transdermal alcohol concentration (TAC), self-reported drinks per week and drinking below NIH low-risk guidelines. FINDINGS Controlling for baseline, CR had a higher percentage of days with no drinking detected (54.3%) than NR (31.2%) during intervention weeks [P = 0.05, Cohen's d = 0.74; 95% confidence interval (CI) = 0.007-1.47]. The longest period of consecutive days with no drinking detected was 8.0 for CR versus 2.9 for NR (P = 0.03, d = 0.85; 95% CI = 0.08-1.61). Peak TAC during intervention showed a non-significant group difference (P = 0.20; d = 0.48; 95% CI = 0.00-1.18); a similar result was found for drinks per week (P = 0.12; d = 0.59; 95% CI = 0.00-1.30). Four times more participants in CR drank below NIH low-risk drinking guidelines during intervention than did participants in NR: 31.1 versus 7.1% (P = 0.07; d = 0.71; 95% CI = -0.04 to 1.46). At 1-month follow-up, the highest number of consecutive days without drinking (self-report) did not differ significantly between conditions (P = 0.26), but showed a medium effect size (d = 0.44; 95% CI = -0.32 to 1.18). CONCLUSIONS Cash incentives linked to a transdermal alcohol sensor can reduce heavy alcohol consumption while the incentives are in operation.

[1]  W. Miller,et al.  Estimating blood alcohol concentration: two computer programs and their applications in therapy and research. , 1979, Addictive behaviors.

[2]  C. Naranjo,et al.  Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). , 1989, British journal of addiction.

[3]  A. Alterman,et al.  A New Measure of Substance Abuse Treatment Initial Studies of the Treatment Services Review , 1992, The Journal of nervous and mental disease.

[4]  Linda C. Sobell,et al.  Timeline Follow-Back A Technique for Assessing Self-Reported Alcohol Consumption , 1992 .

[5]  G. Badger,et al.  Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. , 1994, Archives of general psychiatry.

[6]  W. Bickel,et al.  Applying behavioral concepts and principles to the treatment of cocaine dependence. , 1994, Drug and alcohol dependence.

[7]  N. Petry,et al.  Give them prizes, and they will come: contingency management for treatment of alcohol dependence. , 2000, Journal of consulting and clinical psychology.

[8]  N. Petry.  A comprehensive guide to the application of contingency management procedures in clinical settings. , 2000, Drug and alcohol dependence.

[9]  N. Petry,et al.  Contingency management in group treatment: a demonstration project in an HIV drop-in center. , 2001, Journal of substance abuse treatment.

[10]  K. Saules,et al.  Reinforcement of counseling attendance and alcohol abstinence in a community-based dual-diagnosis treatment program: a feasibility study. , 2003, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[11]  R. Swift,et al.  Direct measurement of alcohol and its metabolites. , 2003, Addiction.

[12]  T. Killeen,et al.  Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. , 2005, Archives of general psychiatry.

[13]  D. Marlowe,et al.  Do research payments precipitate drug use or coerce participation? , 2005, Drug and alcohol dependence.

[14]  H. Jones,et al.  Cash value of voucher reinforcers in pregnant drug-dependent women. , 2005, Experimental and clinical psychopharmacology.

[15]  Michael Prendergast,et al.  Contingency management for treatment of substance use disorders: a meta-analysis. , 2006, Addiction.

[16]  S. Shoptaw,et al.  Contingency management: Schedule effects , 2006, Psychiatry Research.

[17]  R. J. Long,et al.  Validity of transdermal alcohol monitoring: fixed and self-regulated dosing. , 2006, Alcoholism, clinical and experimental research.

[18]  N. Petry,et al.  Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study. , 2006, Archives of general psychiatry.

[19]  G. Badger,et al.  A meta-analysis of voucher-based reinforcement therapy for substance use disorders. , 2006, Addiction.

[20]  B. Rounsaville,et al.  A Perfect Platform: Combining Contingency Management with Medications for Drug Abuse , 2007, The American journal of drug and alcohol abuse.

[21]  J. Krystal,et al.  Multidimensionality of the Alcohol Withdrawal Symptom Checklist: a factor analysis of the Alcohol Withdrawal Symptom Checklist and CIWA-Ar. , 2007, Alcoholism, clinical and experimental research.

[22]  N. Petry,et al.  Low-cost contingency management in community clinics: delivering incentives partially in group therapy. , 2007, Experimental and clinical psychopharmacology.

[23]  Paul R. Marques,et al.  Evaluating transdermal alcohol measuring devices , 2007 .

[24]  N. Petry,et al.  Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. , 2007, Journal of consulting and clinical psychology.

[25]  C. Wang,et al.  Deconvolving an estimate of breath measured blood alcohol concentration from biosensor collected transdermal ethanol data , 2008, Appl. Math. Comput..

[26]  Mark B Powers,et al.  A meta-analytic review of psychosocial interventions for substance use disorders. , 2008, The American journal of psychiatry.

[27]  N. Petry,et al.  The cost-effectiveness of prize-based and voucher-based contingency management in a population of cocaine- or opioid-dependent outpatients. , 2009, Drug and alcohol dependence.

[28]  H. Moss,et al.  Alcohol biomarkers in applied settings: recent advances and future research opportunities. , 2010, Alcoholism, clinical and experimental research.

[29]  James G. Murphy,et al.  Contingency management for alcohol use reduction: a pilot study using a transdermal alcohol sensor. , 2011, Drug and alcohol dependence.

[30]  Donelle N. Howell,et al.  Voucher-based reinforcement for alcohol abstinence using the ethyl-glucuronide alcohol biomarker. , 2012, Journal of applied behavior analysis.

[31]  G. Marlatt,et al.  Primary outcome indices in illicit drug dependence treatment research: systematic approach to selection and measurement of drug use end-points in clinical trials. , 2012, Addiction.

[32]  N. Petry,et al.  A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. , 2013, Addiction.

[33]  D. Festinger,et al.  Contingency management for cocaine treatment: cash vs. vouchers. , 2014, Journal of substance abuse treatment.

[34]  P. Jatlow,et al.  Ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. , 2014, Alcoholism, clinical and experimental research.

[35]  D. Dougherty,et al.  Do variable rates of alcohol drinking alter the ability to use transdermal alcohol monitors to estimate peak breath alcohol and total number of drinks? , 2014, Alcoholism, clinical and experimental research.

[36]  Yuanyuan Liang,et al.  Accounting for sex-related differences in the estimation of breath alcohol concentrations using transdermal alcohol monitoring , 2014, Psychopharmacology.

[37]  Nancy P Barnett,et al.  Predictors of detection of alcohol use episodes using a transdermal alcohol sensor. , 2014, Experimental and clinical psychopharmacology.

[38]  Yuanyuan Liang,et al.  Use of continuous transdermal alcohol monitoring during a contingency management procedure to reduce excessive alcohol use. , 2014, Drug and alcohol dependence.

[39]  R. Anton.  Commentary on: ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. , 2014, Alcoholism, clinical and experimental research.

[40]  I. Gary Rosen,et al.  Blind deconvolution for distributed parameter systems with unbounded input and output and determining blood alcohol concentration from transdermal biosensor data , 2014, Appl. Math. Comput..

[41]  D. Dougherty,et al.  Using contingency management procedures to reduce at-risk drinking in heavy drinkers. , 2015, Alcoholism, clinical and experimental research.

[42]  Yuanyuan Liang,et al.  Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking. , 2015, Drug and alcohol dependence.

[43]  Zheng Dai,et al.  Using drinking data and pharmacokinetic modeling to calibrate transport model and blind deconvolution based data analysis software for transdermal alcohol biosensors. , 2016, Mathematical biosciences and engineering : MBE.