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

在美国，酒精每年导致8.8万人死亡，估计造成2230亿美元的损失。酒精 使用障碍(AUD)在退伍军人中非常普遍；估计有32%的退伍军人符合AUD的诊断标准。 减少患有AUD的退伍军人中大量饮酒对公共健康的积极影响将防止显著 医疗发病率和死亡率。行为激励可以增加治疗保留率和戒断率 在患有澳元的退伍军人中。应急管理(CM)是一种强化的行为疗法，它提供了 鼓励个人滥用物质。CM表现出的影响大小超过了其他行为 多种药物滥用的治疗，包括一项对患有AUD的退伍军人的试验，该试验表明CM 两者都提高了治疗保留率和完成率，并与从 酒精与标准治疗的比较。然而，迄今为止，CM干预措施的实施在很大程度上 重点关注兴奋剂使用障碍(如可卡因；甲基苯丙胺)，原因是难以监测戒毒情况 酒精，这需要每天监测。因此，尽管已证明有效，但CM仍可用于治疗 目前澳元不适用于澳元患者。我们小组开发了一款移动智能手机应用程序 这使得患者可以使用FDA批准的小型酒精呼气监测器拍摄自己的视频，并将 将加密数据发送到安全服务器。这一创新使得将CM用于门诊AUD治疗是可行的。 使用移动CM(MCM)结合循证认知行为疗法(CBT)治疗AUD将 显著提高澳大利亚退伍军人的长期禁酒率和重度饮酒天数。 目前研究的目的是评估应急管理的有效性和成本效益。 作为酒精使用障碍认知行为疗法的辅助手段。试验还将探索潜在的用途 关于治疗利用和酒精结果的长期禁欲激励。提议的是比较级的 有效性试验采用2×2析因设计，其中160名患有AUD的退伍军人将被主动招募并 随机接受CM作为最先进的基于证据的CBT的辅助或单独接受CBT； 两个长期奖励条件(即，在6-6岁时获得戒酒/低风险饮酒的金钱奖励-- 几个月与没有激励)。该项目旨在通过1)测试移动设备的有效性来推进AUD的治疗 健康方法，使澳大利亚的CM可行；2)提供急需的成本效益数据 使用行为激励作为CBT的辅助手段来治疗AUD。这些目标旨在解决 对澳元病实施有效的CM的两个重要障碍。

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.