A preliminary randomized controlled trial of contingency management for alcohol use reduction using a transdermal alcohol sensor.
A preliminary randomized controlled trial of contingency management for alcohol use reduction using a transdermal alcohol sensor.
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DOI：
10.1111/add.13767
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发表时间：
2017-06
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通讯作者：
Swift RM
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作者：
Barnett NP;Celio MA;Tidey JW;Murphy JG;Colby SM;Swift RM
我们使用经皮酒精传感器检测酒精使用情况，测试了每日或有强化与(带锁)非或有强化(NR)相比在减少酒精使用方面的有效性。飞行员随机对照设计，包括一个基线周、三个干预周和一个月的随访。美国新英格兰。未寻求治疗的酗酒成年人(46.7%女性)被随机分为1)现金强化计划(CR；n=15)，持续时间为未报告或检测到酒精的天数；或2)挂钩的NR(n=15)。CR参与者的增强剂从5美元开始，在随后没有检测到或报告酒精的日子里增加2美元，最高为17美元。参与者在检测到或报告饮酒的日子里没有得到增强剂，饮酒后第二天增强剂的值重新设置为5美元。NR参与者按照登记的顺序，与CR条件下个体的每日强化值挂钩。因此，CR和NR的配对参与者获得了相同数额的钱，但NR参与者的金额与行为无关。主要结果是没有传感器检测到饮酒的天数百分比。次要结果是连续未检测到饮酒的天数、最高经皮酒精浓度(TAC)、自我报告的每周饮酒量以及饮酒量低于NIH低风险指南。对照基线，在干预周内，CR组未发现饮酒的天数百分比(54.3%)高于非饮酒组(31.2%)(p=0.05，Cohen‘s d=0.74；95%CI：007-1.47)。连续未检测到饮酒的最长天数，CR组为8.0天，NR组为2.9天(p=0.03，d=0.85；95%CI：0.08-1.61)。干预期间的峰值TAC显示出无显著差异(p=.20；d=.48；95%CI：.00-1.18)；每周饮酒的结果相似(p=.12；d=.59；95%CI：.00-1.30)。在干预期间，CR组的参与者饮酒低于NIH低风险饮酒指南的人数是NR组的四倍：31.1%对7.1%(p=0.07；d=.71；95%CI：−0.04-1.46)。在1个月的随访中，连续不饮酒的最高天数(自我报告)在不同情况下没有显著差异(p=.26)，但显示出中等效果(d=.44；95%CI：−.32-1.18)。与透皮酒精传感器挂钩的现金激励措施可以在激励措施实施期间减少大量酒精消费。
We tested the efficacy of daily contingent reinforcement for reducing alcohol use compared with (yoked) noncontingent reinforcement (NR) using a transdermal alcohol sensor to detect alcohol use. Pilot randomized controlled design with one baseline week, three intervention weeks, and one-month follow up. New England, USA. 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). 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. The primary outcome was percent 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. Controlling for baseline, CR had higher percent days with no drinking detected (54.3%) than NR (31.2%) during intervention weeks (p = .05, Cohen’s d = 0.74; 95% CI: 007–1.47). The longest period of consecutive days with no drinking detected was 8.0 for CR vs. 2.9 for NR (p = .03, d = 0.85; 95% CI: .08–1.61). Peak TAC during intervention showed a nonsignificant group difference (p = .20; d = .48; 95% CI: .00–1.18); a similar result was found for drinks per week (p = .12; d = .59; 95% CI: .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% vs. 7.1% (p = .07; d = .71; 95% CI: −0.04–1.46). At 1-month follow up, the highest number of consecutive days without drinking (self-report) did not differ significantly between conditions (p = .26), but showed a medium effect size (d = .44; 95% CI: −.32–1.18). Cash incentives linked to a transdermal alcohol sensor can reduce heavy alcohol consumption while the incentives are in operation.