Effectiveness and Outcomes of Combined Contingency Management and CBT for Alcohol Use Disorder

在美国，酒精导致88，000人死亡，估计每年花费2230亿美元。醇 使用障碍（AUD）在退伍军人中非常普遍;估计32%的退伍军人符合AUD的诊断标准。 减少患有AUD的退伍军人大量饮酒的积极公共卫生影响将防止显著的 医学发病率和死亡率。行为激励可以增加治疗保留率和增加戒断率 在与AUD的退伍军人。应急管理（CM）是一种强化的行为疗法， 鼓励个人滥用药物。CM已经证明了超过其他行为的效应大小 多种药物滥用的治疗，包括在患有AUD的退伍军人中进行的试验，该试验表明CM 治疗保持率和完成率均增加，并且与 酒精与标准治疗相比然而，迄今为止，CM干预措施的实施在很大程度上 专注于兴奋剂使用障碍（例如，可卡因;甲基苯丙胺），原因是难以监测戒断情况 酒精，这需要每天监测。因此，尽管证明了疗效，CM方法用于治疗 AUD目前不适用于持有AUD的人。我们小组开发了一个移动的智能手机应用程序 允许患者使用FDA批准的小型酒精呼吸监测器拍摄自己的视频， 加密数据到安全服务器。这一创新使CM用于门诊AUD治疗变得可行。 使用移动的CM（mCM）结合循证认知行为疗法（CBT）治疗AUD， 显著提高了AUD退伍军人长期戒酒率并减少了大量饮酒天数。 本研究的目的是评估应急管理的有效性和成本效益 作为酒精使用障碍的认知行为疗法的辅助手段。试验还将探索潜在的效用 长期戒酒激励对治疗利用和酒精结果的影响。建议是一个比较 采用2 x 2析因设计的有效性试验，其中将主动招募160名患有AUD的退伍军人， 随机接受CM作为最新循证CBT的辅助治疗或单独接受CBT; 两个长期激励条件（即，在6岁时获得戒酒/低风险饮酒的金钱奖励- 月与无激励）。该项目旨在通过1）测试移动的 健康方法，使CM为AUD可行，2）提供急需的成本效益数据， 使用行为激励作为CBT治疗AUD的辅助手段。这些目标旨在解决 对AUD实施有效CM的两个重大障碍。

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.