Piloting Deposit Contracts to Increase Accessibility of a Contingency Management Intervention to Reduce Problematic Drinking

项目概要/摘要 在美国，问题饮酒是可预防的发病率和死亡率的主要原因， 然而，有效的干预措施往往仍然难以获得。作为回应，本R21申请建议 将我们先前开发的基于激励的干预措施转化为可持续的、易于获得的 使用远程酒精监测和存款合同进行干预，针对那些不愿意 由于时间限制、态度和耻辱等障碍，更多的人接受传统的治疗。 基于激励的干预措施非常有效，可以克服其中许多障碍， 对那些不寻求更正式的药物滥用治疗的人有吸引力。之前我们演示了 一种这样的基于激励的干预（即，应急管理）提供每周付款， 远程酒精监测有效地减少了危险饮酒。然而，应急管理 像我们这样的干预措施在很大程度上仍然无法实现，这是由于三个普遍存在的问题：（1）客观地检测 酒精消费是困难的（我们已经克服了远程酒精监测）;（2）提供incen- 风险使应急管理变得昂贵;（3）应急管理被一些人视为 道德上有问题，因为它奖励客户不从事他们不应该追求的行为， 反正为了减轻这些担忧，我们建议使用存款合同。存款合同：（a） 个人投资他们自己的钱，如果达到指定的目标（或应急），这些钱就会赚回来;以及（B） 远程酒精监测和电子支付，避免频繁的诊所访问。就像应急人- 然而，存款合同为没有问题饮酒提供了激励，但激励来自于 参与者自己。存款合同比应急管理成本低， 通过让参与者奖励自己减少问题饮酒来反对。 这项拟议的试点研究将通过招募酗酒者来探索存款合同的可行性 个人进入存款合同干预，旨在减少他们的问题饮酒（目标1），并发展 存款合同有效性和成本中性的证据（目标2）。这种干预将减少 限制可访问性的障碍（如成本、时间和旅行）和伦理问题。这个项目是及时的， 由于十几家公司正在开发“Fitbit”式的酒精监测设备，其中许多现在已经 正在进行试点和验证工作，为消费者使用做准备（我们是一家独立验证 一个这样的装置）。拟议的工作将证明可行性，提供有效性的初步证据， 为更大规模的干预研究奠定基础， 以新颖和可持续的方式减少问题饮酒。

Project Summary/Abstract Problem drinking is a leading cause of preventable morbidity and mortality in the US, with high economic cost; however, effective interventions often remain inaccessible. In response, this R21 application proposes to translate our previously developed incentive-based intervention into a sustainable, easily accessible intervention using remote alcohol monitoring and deposit contracts, targeting individuals who would not be reached by more traditional forms of treatment due to barriers such as time constraints, attitudes, and stigma. Incentive-based interventions are highly effective and overcome many of these barriers and can be attractive to people not seeking more formal treatment for their substance abuse. Previously we demonstrated that one such incentive-based intervention (i.e., contingency management) providing weekly payments based on remote alcohol monitoring effectively reduces dangerous drinking. However, contingency management interventions like ours remain largely inaccessible due three widely held concerns: (1) objectively detecting alcohol consumption is difficult (which we have overcome with remote alcohol monitoring); (2) providing incen- tives makes contingency management expensive; and (3) contingency management is viewed by some as ethically questionable, because it rewards clients for not engaging in behaviors they should not pursue anyway. To alleviate these concerns, we propose using deposit contracts. With deposit contracts: (a) individuals invest their own money, which is earned back if a specified goal (or contingency) is met; and (b) remote alcohol monitoring and electronic payment, obviate frequent clinic visits. Like contingency man- agement, deposit contracts provide incentives for the absence of problem drinking, but incentives come from participants themselves. Deposit contracts are less expensive than contingency management and reduce eth- ical objections by having participants reward themselves for reducing problematic drinking. This proposed pilot study will explore the feasibility of deposit contracts by recruiting heavy-drinking individuals into a deposit contract intervention aimed at reducing their problem drinking (Aim 1) and develop evidence of deposit contract effectiveness and cost-neutrality (Aim 2). Such an intervention would reduce barriers that limit accessibility (such as cost, time, and travel) and ethical concerns. This project is timely, since over a dozen companies are developing “Fitbit”-style alcohol monitoring devices, many of which are now undergoing pilot and validation work in preparation for consumer use (we are a site independently validating one such device). The work proposed will demonstrate feasibility, provide initial evidence of effectiveness, and lay the groundwork for a much larger study of an intervention that could be made widely accessible for reducing problem drinking in a novel and sustainable manner.