Piloting Deposit Contracts to Increase Accessibility of a Contingency Management Intervention to Reduce Problematic Drinking

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Project Summary/Abstract Problem drinking is a leading cause of preventable morbidity and mortality in the US, with high economic cost; however, effective interventions often remain inaccessible. In response, this R21 application proposes to translate our previously developed incentive-based intervention into a sustainable, easily accessible intervention using remote alcohol monitoring and deposit contracts, targeting individuals who would not be reached by more traditional forms of treatment due to barriers such as time constraints, attitudes, and stigma. Incentive-based interventions are highly effective and overcome many of these barriers and can be attractive to people not seeking more formal treatment for their substance abuse. Previously we demonstrated that one such incentive-based intervention (i.e., contingency management) providing weekly payments based on remote alcohol monitoring effectively reduces dangerous drinking. However, contingency management interventions like ours remain largely inaccessible due three widely held concerns: (1) objectively detecting alcohol consumption is difficult (which we have overcome with remote alcohol monitoring); (2) providing incen- tives makes contingency management expensive; and (3) contingency management is viewed by some as ethically questionable, because it rewards clients for not engaging in behaviors they should not pursue anyway. To alleviate these concerns, we propose using deposit contracts. With deposit contracts: (a) individuals invest their own money, which is earned back if a specified goal (or contingency) is met; and (b) remote alcohol monitoring and electronic payment, obviate frequent clinic visits. Like contingency man- agement, deposit contracts provide incentives for the absence of problem drinking, but incentives come from participants themselves. Deposit contracts are less expensive than contingency management and reduce eth- ical objections by having participants reward themselves for reducing problematic drinking. This proposed pilot study will explore the feasibility of deposit contracts by recruiting heavy-drinking individuals into a deposit contract intervention aimed at reducing their problem drinking (Aim 1) and develop evidence of deposit contract effectiveness and cost-neutrality (Aim 2). Such an intervention would reduce barriers that limit accessibility (such as cost, time, and travel) and ethical concerns. This project is timely, since over a dozen companies are developing “Fitbit”-style alcohol monitoring devices, many of which are now undergoing pilot and validation work in preparation for consumer use (we are a site independently validating one such device). The work proposed will demonstrate feasibility, provide initial evidence of effectiveness, and lay the groundwork for a much larger study of an intervention that could be made widely accessible for reducing problem drinking in a novel and sustainable manner.