Contingency Management for Alcohol Use Disorders

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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.