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

试行押金合同，以提高应急管理干预的可及性，从而减少饮酒问题

• 批准号: 10333648
• 负责人: Donald M Dougherty
• 金额: $ 18.69万
• 依托单位: UNIVERSITY OF NORTH TEXAS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10333648
• 关键词: Alcohol abuse; Alcohol consumption; Alcohols; Attitude; Back; Behavior; Body Weight decreased; Caring; Chronic; Client; Clinic Visits; Contracts; Dangerousness; Deposition; Devices; Effectiveness; Enrollment; Ethics; Face; Funding; Goals; Grant; Health; Heavy Drinking; Incentives; Individual; Intervention; Intervention Studies; Monitor; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Perception; Persons; Pilot Projects; Preparation; Procedures; Public Health; Randomized; Reporting; Research; Rewards; Site; Specific qualifier value; Strategic Planning; Substance abuse problem; Time; Translating; Translations; Travel; Validation; Visit; Weight; Work; alcohol misuse; alcohol monitoring; base; contingency management; cost; cost estimate; drinking; economic cost; effective intervention; fitbit; incentive-based intervention; innovation; interest; intervention cost; meetings; monitoring device; mortality; novel; payment; prevent; programs; recruit; response; sensor; social stigma

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.

项目概要/摘要 在美国，饮酒问题是可预防的发病率和死亡率的主要原因，经济损失惨重。 成本;然而，有效的干预措施往往仍然难以实现。作为回应，该 R21 申请建议 将我们之前开发的基于激励的干预措施转化为可持续的、易于获得的 使用远程酒精监测和存款合同进行干预，针对那些不会参与的个人 由于时间限制、态度和耻辱等障碍，只能采用更传统的治疗形式。 基于激励的干预措施非常有效，可以克服许多障碍 对于那些不寻求更正规的药物滥用治疗的人来说很有吸引力。之前我们演示过 一种基于激励的干预措施（即应急管理）提供基于每周付款的 远程酒精监测有效减少危险饮酒。然而，应急管理 由于三个广泛存在的担忧，像我们这样的干预措施仍然基本上无法实现：（1）客观地检测 饮酒困难（我们通过远程酒精监控克服了这一问题）； (2) 提供煽动 因素使得应急管理成本高昂； (3) 一些人认为应急管理是 在道德上是有问题的，因为它奖励客户不从事他们不应该追求的行为 反正。为了减轻这些担忧，我们建议使用存款合约。对于存款合同：(a) 个人投资自己的钱，如果达到指定的目标（或意外情况），则可以收回这笔钱； (b) 远程酒精监测和电子支付，避免频繁就诊。就像应急人员一样—— 年龄阶段，存款合同为不存在饮酒问题提供了激励，但激励来自于 参与者自己。存款合同比应急管理成本更低，并且可以减少道德风险 通过让参与者奖励自己减少酗酒问题来提出反对意见。 这项拟议的试点研究将通过招募酗酒者来探索存款合同的可行性 个人进行存款合同干预，旨在减少饮酒问题（目标 1）并发展 存款合同有效性和成本中性的证据（目标 2）。这样的干预将减少 限制可及性的障碍（例如成本、时间和旅行）和道德问题。这个项目来得正是时候， 因为十几家公司正在开发“Fitbit”式酒精监测设备，其中许多现在已经上市 正在进行试点和验证工作，为消费者使用做好准备（我们是一个独立验证的网站 一个这样的设备）。拟议的工作将证明可行性，提供有效性的初步证据，以及 为更广泛的干预措施研究奠定基础，该干预措施可以广泛应用于 以新颖且可持续的方式减少饮酒问题。