Contingency Management for Alcohol Abuse Using Transdermal Alcohol Detection

描述（由申请人提供）：预防和治疗酒精滥用是一个重要的研究和公共卫生优先事项。迄今为止，最有希望的物质使用方法之一 减少，应急管理（CM），还没有很好地研究了酒精滥用者。应急管理干预措施为物质使用者提供现金、代金券或其他一些取决于期望的治疗目标的奖励。CM尚未作为酒精治疗进行广泛研究的主要原因是，由于肝脏对酒精的快速代谢，因此没有可靠可行的方法来验证戒酒或饮酒减少。然而，现在可获得的设备基于在患者体内的酒精浓度提供酒精使用的指示。 出汗。透皮传感器佩戴在皮肤附近，可以远程监控，这使得立即加强禁欲或减少成为可能。本提案的目的是研究CM在愿意减少或停止饮酒的重度饮酒者中减少饮酒的初步疗效。在对15人组（目标1）的既定程序、数据收集和干预组件进行必要调整后，我们将进行一项小型（N = 30）临床试验，其中我们将比较3周CM条件与非条件性强化（NR）（目标2）。 CM中的参与者将接受强化，这取决于通过透皮酒精监测仪测量的保持禁欲; NR中的参与者将接受与其透皮酒精水平无关的轭式强化。一个项目网站将用于收集每日饮酒记录，向参与者提供有关酒精检测的反馈，并提供酒精检测器。经皮酒精浓度和自我报告数据将提供有关治疗积极阶段饮酒变化的信息，1个月的随访评估将衡量干预后的短期结果。建立这些组成部分和CM的初始效应量是CM和酒精监测治疗酒精滥用和依赖的研究计划中必不可少的第一步。我们的最终目标是进行更大规模的临床试验，以更严格地评估CM与此和其他高风险饮酒人群的短期和长期结果。

DESCRIPTION (provided by applicant): Prevention and treatment of alcohol abuse is a significant research and public health priority. To date one of the most promising approaches for substance use reduction, contingency management (CM), has not been well studied with alcohol abusers. Contingency management interventions provide substance users with cash, vouchers, or some other reinforcer that is contingent upon a desired treatment goal. A primary reason that CM has not been widely studied as an alcohol treatment is that due the rapid metabolism of alcohol by the liver there has not been a reliable and feasible way to verify abstinence or drinking reductions. However, devices are now available that provide an indication of alcohol use based on the concentration of alcohol in perspiration. A transdermal sensor is worn close to the skin and can be monitored remotely, which makes it possible to immediately reinforce abstinence or reduction. The objective of this proposal is to study the initial efficacy of CM for reducing drinking among heavy drinkers who are willing to reduce or stop drinking. Following necessary adaptations to established procedural, data collection, and intervention components with group of 15 (Aim 1), we will conduct a small (N = 30) clinical trial in which we will compare a 3-week CM condition to yoked noncontingent reinforcement (NR) (Aim 2). Participants in CM will receive reinforcement that is contingent upon maintaining abstinence as measured by a transdermal alcohol monitor; participants in NR will receive yoked reinforcement that is not contingent on their transdermal alcohol levels. A project website will be used to collect daily records of drinking, provide feedback about detection of alcohol to participants, and provide reinforcers. Transdermal alcohol concentrations and self-report data will provide information about changes in drinking during the active phase of treatment, and a 1-month follow-up assessment will measure short-term post-intervention outcomes. Establishing these components and an initial effect size for CM are essential first steps in a program of research with CM and alcohol monitoring to treat alcohol misuse and dependence. Our eventual goal is to conduct larger clinical trials to more rigorously evaluate the short and long-term outcomes of CM with this and other high-risk drinking populations.