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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

基本信息

批准号：
10529075
负责人：
PATRICK S. CALHOUN
金额：
$ 12.58万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
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/10529075
关键词：
Abstinence Address Afghanistan Aftercare Alcohols Behavior Therapy Behavioral Caring Cessation of life Clinic Cocaine Cognitive Therapy Data 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 Persons 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 diagnostic criteria drug abstinence effectiveness evaluation effectiveness outcome effectiveness testing encryption evidence base follow-up high risk drinking implementation barriers improved incremental cost-effectiveness innovation mHealth medical specialties mortality multidrug abuse prevent recruit smartphone Application standard care stimulant use disorder substance misuse voucher

项目摘要

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，并造成2230亿美元的损失。酒精