Contingency Management for Alcohol Use Disorders

描述(由申请人提供)：应急管理(CM)治疗在改善药物滥用患者的预后方面非常有效。然而，CM很少被应用于酒精使用障碍的个人，主要是因为在监测饮酒方面的技术限制。安全连续远程酒精监测(SCRAMx(R))是一项新技术，旨在每周7天、每天24小时持续监测酒精消费。该系统可能非常适合用于酒精使用障碍患者的CM试验。本研究的目的是使用SCRAMx评估中药在减少酒精使用方面的效果。总体而言，120名在社区诊所开始门诊治疗的酗酒或依赖患者将被随机分配到两种情况之一：标准护理，或标准护理加基于SCRAMx读数结果的强化CM。研究干预将持续12周，在基线、治疗后和整个一年的随访期间进行评估。所有参与者在12周的研究期间都将佩戴SCRAMx监测仪，作为饮酒的客观指标，并在后续研究中再次佩戴。与标准护理相比，我们预计CM将导致饮酒天数减少，连续不饮酒天数延长。我们还将评估CM对酒精结果的长期影响，并假设在治疗期间长时间不饮酒将导致在接下来的治疗期间饮酒率较低。此外，我们将探索冲动与治疗结果的关系，以及冲动是否缓和或调节饮酒结果。CM还有望减少其他药物使用和艾滋病毒危险行为，这些行为与酒精使用有着错综复杂的联系。最后，我们将评估CM的成本效益和潜在的成本效益。尽管这种疗法明显增加了成本，但在减少饮酒方面，它可能比标准护理更具成本效益，这项研究将估计在什么条件下它可能对哪些患者具有成本效益。这项研究的结果将为将CM整合到酒精使用障碍的治疗中铺平道路，并在临床试验中使用这项新技术。

DESCRIPTION (provided by applicant): Contingency management (CM) treatments are highly efficacious in improving outcomes of substance abusing patients. However, CM has rarely been applied to individuals with alcohol use disorders, primarily because of technological limitations in monitoring drinking. The Secure Continuous Remote Alcohol Monitor (SCRAMx(R)) is a new technology designed to continuously monitor alcohol consumption 24 hours a day for 7 days per week. This system may be ideal for use in CM trials with patients with alcohol use disorders. The purpose of this study is to evaluate the efficacy of CM in reducing alcohol use using SCRAMx. In total, 120 alcohol abusing or dependent patients initiating outpatient treatment at community-based clinics will be randomly assigned to one of two conditions: standard care, or standard care plus CM with reinforcement based on results of SCRAMx readings. Study interventions will last for 12 weeks, with assessments conducted at baseline, post-treatment and throughout a one-year follow-up. All participants will wear SCRAMx monitors throughout the 12-week study period as an objective indicator of alcohol use, and again at follow-up. Compared with standard care, we expect that CM will result in fewer drinking days and longer durations of continuous non-drinking days. We will evaluate the long-term effects of CM on alcohol outcomes as well, and we hypothesize that long durations of non-drinking during the treatment period will result in lower rates of drinking throughout the follow-u period. In addition, we will explore the association of impulsivity with treatment outcomes, and whether impulsivity moderates or mediates drinking outcomes. CM is also expected to reduce other drug use and HIV risk behaviors, which are intricately linked with alcohol use. Finally, we will assess the cost-effectiveness and potential cost-benefits of CM. Although this treatment clearly adds costs, it may be more cost-effective in reducing drinking than standard care, and this study will estimate the conditions under which and patient populations for whom it may be cost effective. Results from this study will be important for paving the way toward integrating CM into treatment for alcohol use disorders and for utilizing this new technology in clinical trials.