Effectiveness and Outcomes of Combined Contingency Management and CBT for Alcohol Use Disorder

应急管理和 CBT 联合治疗酒精使用障碍的有效性和结果

• 批准号: 10172808
• 负责人: PATRICK S. CALHOUN
• 金额: $ 66.23万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10172808
• 关键词: Abstinence; Address; Afghanistan; Aftercare; Alcohols; Behavior Therapy; Behavioral; Caring; Cessation of life; Clinic; Cocaine; Cognitive Therapy; Data; Diagnostic; Disease; Drug usage; FDA approved; Goals; Health Technology; Heavy Drinking; Incentives; Individual; Integrated Health Care Systems; Intervention; Iraq; Measures; Medical; Methamphetamine; Monitor; Morbidity - disease rate; Outcome; Outpatients; Patient Self-Report; Patients; Public Health; Quality-Adjusted Life Years; Randomized; Recording of previous events; Rewards; Secure; Substance Use Disorder; Substance abuse problem; United States; Veterans; Veterans Health Administration; alcohol abstinence; alcohol abuse therapy; alcohol misuse; alcohol monitoring; alcohol use disorder; comparative cost effectiveness; comparative effectiveness trial; contingency management; cost effective treatment; cost effectiveness; cost estimate; cost-effectiveness evaluation; cost-effectiveness ratio; design; drug abstinence; effectiveness evaluation; effectiveness outcome; effectiveness testing; encryption; evidence base; follow-up; high risk drinking; improved; incremental cost-effectiveness; innovation; mHealth; medical specialties; mortality; multidrug abuse; prevent; recruit; smartphone Application; standard care; stimulant use disorder; substance misuse; voucher

Alcohol contributes to 88,000 deaths and costs an estimated $223 billion annually in the United States. Alcohol use disorder (AUD) is highly prevalent in veterans; an estimated 32% of veterans meet diagnostic criteria for AUD. The positive public health impact of reducing heavy drinking among veterans with AUD would prevent significant medical morbidity and mortality. Behavioral incentives could increase treatment retention and increase abstinence among Veterans with AUD. Contingency management (CM) is an intensive behavioral therapy that provides incentives to individuals misusing substances. CM has demonstrated effect sizes beyond that of other behavioral treatments across multiple drugs of abuse, including a trial in Veterans with AUD, which demonstrated that CM both increased treatment retention and completion rates and was associated with increased abstinenence from alcohol compared to standard treatment. To date, however, implementation of CM interventions has largely focused on stimulant use disorders (e.g., cocaine; methamphetamine) due to the diffculty of monitoring abstinence from alcohol, which requires daily monitoring. Thus, despite demonstrated efficacy, CM aproaches for treatment of AUD are not currently available to people with AUD. Our group has developed a mobile smart-phone application that allows patients to video themselves using a small FDA-approved alcohol breath monitor and transmits the encrypted data to a secure server. This innovation has made the use of CM for outpatient AUD treatment feasible. Targeting AUD with mobile CM (mCM) paired with evidenced-based cognitive behavioral therapy (CBT) will significantly improve long-term abstinence rates and reduction in heavy drinking days among Veterans with AUD. The aim of the current study is to evaluate the effectiveness and cost effectiveness of contingency management as an adjunct to cognitive behavioral therapy for alcohol use disorders. The trial will also explore the potential utilty of a long-term abstinence incentive on treatment utilization and alcohol outcomes. Proposed is a comparative effectiveness trial with a 2 x 2 factorial design in which 160 Veterans with AUD will be proactively recruited and randomized to receive either CM as an adjunct to state-of-the-art evidenced-based CBT or CBT alone; and to one of two long-term incentive conditions (i.e., receipt of a monetery incentive for abstinence/low-risk drinking at 6- months vs. no incentive). This project aims to advance AUD treatment by 1) testing the effectiveness of a mobile health approach that makes CM for AUD feasible, and 2) providing highly needed cost-effectiveness data on the use of behavioral incentives as an adjunct to CBT for the treatment of AUD. These aims are designed to address two significant barriers to the implementation of efficacious CM for AUD.

在美国，酒精每年导致 88,000 人死亡，造成的损失估计达 2,230 亿美元。酒精 使用障碍（AUD）在退伍军人中非常普遍；据估计，32% 的退伍军人符合 AUD 的诊断标准。 减少 AUD 退伍军人酗酒对公共健康的积极影响将防止严重的 医疗发病率和死亡率。行为激励可以提高治疗保留率并提高戒断率 退伍军人中持有澳元。应急管理 (CM) 是一种强化行为疗法，可提供 对个人滥用物质的激励。 CM 已证明其效果超出其他行为 多种滥用药物的治疗，包括在退伍军人中使用 AUD 进行的试验，该试验表明 CM 两者都增加了治疗保留率和完成率，并且与戒断率增加相关 与标准治疗相比，酒精治疗。然而，迄今为止，CM 干预措施的实施在很大程度上已 由于难以监测戒断情况，重点关注兴奋剂使用障碍（例如可卡因、甲基苯丙胺） 来自酒精，这需要日常监测。因此，尽管已证实有效，但 CM 仍致力于治疗 目前持有 AUD 的人士无法使用 AUD。我们小组开发了一款移动智能手机应用程序 允许患者使用 FDA 批准的小型酒精呼吸监测仪拍摄自己的视频，并传输 加密数据传输到安全服务器。这一创新使得使用 CM 进行门诊 AUD 治疗成为可能。 以 AUD 为目标，采用移动 CM (mCM) 结合循证认知行为疗法 (CBT) 将 显着提高持有 AUD 的退伍军人的长期戒酒率并减少酗酒天数。 当前研究的目的是评估应急管理的有效性和成本效益 作为酒精使用障碍认知行为疗法的辅助手段。该试验还将探索潜在的效用 长期戒酒激励对治疗利用和酒精结果的影响。建议是比较 采用 2 x 2 因子设计的有效性试验，其中将主动招募 160 名持有 AUD 的退伍军人，并 随机接受 CM 作为最先进的循证 CBT 的辅助治疗或单独接受 CBT；和一个 两个长期激励条件（即，在 6 岁以下时获得禁欲/低风险饮酒的金钱激励） 月与无激励）。该项目旨在通过 1) 测试移动设备的有效性来推进 AUD 治疗 使澳元的 CM 可行的健康方法，以及 2) 提供急需的成本效益数据 使用行为激励作为 CBT 的辅助治疗 AUD。这些目标旨在解决 澳元实施有效的 CM 存在两个重大障碍。