Novel EtG BasedContingency Management for Alcohol in the Severely Mentally Ill
基于 EtG 的新型严重精神疾病患者酒精应急管理
基本信息
- 批准号:9390731
- 负责人:
- 金额:$ 68.17万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2012
- 资助国家:美国
- 起止时间:2012-03-10 至 2022-08-31
- 项目状态:已结题
- 来源:
- 关键词:AbstinenceAdultAffectAlcohol consumptionAlcoholic beverage heavy drinkerAlcoholsAmericanBehavior TherapyBiological MarkersBipolar DisorderCharacteristicsCigarette SmokerCocaine DependenceComplexConsumptionCost Effectiveness AnalysisCosts and BenefitsDropoutDrug resistanceDrug usageDrug userEconomicsEmotionalExecutive DysfunctionFundingGlucuronidesHIV InfectionsHIV riskHeavy DrinkingHomelessnessHospitalizationHourIncentivesIndividualInterventionJournalsLightMajor Depressive DisorderMentally Ill PersonsModificationNational Institute on Alcohol Abuse and AlcoholismNicotine DependenceOutcomeParticipantPatient Self-ReportPatientsPersonsPharmaceutical PreparationsPopulationPsychiatryPsychological reinforcementRandomizedRecruitment ActivityRecurrenceReportingResearchRewardsRisk BehaviorsSamplingSchizophreniaShapesTestingTheoretical modelTimeTreatment outcomeUrineaddictionalcohol abstinencealcohol abuse therapyalcohol measurementalcohol reinforcementalcohol rewardalcohol use disorderbasecigarette smokingcomparative efficacycontingency managementcostcost effectivecost effectivenessdrinkingdrug abstinenceexecutive functionexperiencefollow-upimproved outcomeincentive saliencenovelprimary outcomerandomized trialreinforcerrelative costsecondary outcomesevere mental illnesstreatment as usualtreatment responseweek trial
项目摘要
ABSTRACT
The objective of this competing continuation (renewal) application is to determine whether modifications to a
contingency management (CM) intervention improve outcomes and reduce costs in heavy drinkers with
serious mental illness (SMI). Up to 46% of adults with SMI experience an alcohol use disorder in their lifetimes.
Alcohol use contributes to high rates of homelessness, psychiatric hospitalization, HIV infection, cigarette
smoking, and drug use in this population, for which CM is an especially promising treatment. In CM, patients
receive tangible rewards for demonstrating drug abstinence. CM for alcohol use requires a biomarker that can
detect alcohol use for more than 48 hours after consumption. As no such biomarker was available until
recently, little research has investigated CM as a treatment for alcohol use disorders. In our initial funding
period we found that the alcohol biomarker ethyl glucuronide (EtG) can detect drinking for up to 5 days when
administered as part of a randomized 12-week trial of CM. Those randomized to EtG-based CM were 3 times
more likely to submit alcohol-negative EtG tests than controls. CM participants also had lower levels of heavy
drinking, stimulant drug use, and cigarette smoking than controls. However, CM was ineffective for participants
with an average pre-treatment EtG level that indicated frequent, recent heavy drinking (EtG > 499 ng/mL). We
propose to investigate whether 2 strategies – a) increasing reinforcer magnitude or b) reinforcing light drinking
before reinforcing abstinence – can improve outcomes in heavy drinkers with SMI. While initial research
indicates that these strategies are associated with improved outcomes in treatment-resistant drug users and
cigarette smokers, no randomized trial has compared them, investigated them in alcohol users or adults with
SMI, investigated their relative cost-effectiveness, or investigated modifiers of CM efficacy using a theoretical
model. Therefore, we will compare the efficacy of these 2 approaches to the CM intervention implemented in
the initial funding period in heavy drinkers with SMI. A total of 400 participants receiving treatment as usual at 2
treatment agencies will take part in a 4-week induction period. Participants (n=240) who attain a mean EtG >
499 ng/mL during the induction period will be randomized to either a) 4 months of standard-magnitude
reinforcement CM for submitting alcohol-abstinent EtG samples (EtG < 100 ng/mL) (Usual CM), b) 4 months of
high-magnitude CM for submitting alcohol-abstinent EtG samples (High-Magnitude CM), or c) 1 month of CM
for submitting alcohol samples that indicate light drinking (EtG < 500 ng/mL), followed by 3 months of CM for
submitting alcohol-abstinent EtG samples (Shaping CM). The primary outcome will be EtG-verified alcohol
abstinence during the last 3 months of treatment (when all reinforcement is contingent on abstinence) and
during 6 months of follow-up. We will also investigate group differences in secondary outcomes, conduct a
comprehensive economic analysis of CM conditions, and determine whether variables that make up the NIAAA
Addictions Neuroclinical Assessment framework moderate alcohol abstinence in the 3 CM conditions.
摘要
这种竞争性延续(续期)申请的目的是确定是否对
应急管理(CM)干预可改善重度饮酒者的结局并降低成本,
严重精神疾病(SMI)。高达46%的成年SMI患者在其一生中经历过酒精使用障碍。
酗酒导致无家可归、精神病住院、艾滋病毒感染、吸烟的比例很高
吸烟和药物使用,CM是一种特别有前途的治疗方法。在CM中,患者
因为表现出戒毒而获得切实的奖励。酒精使用的CM需要生物标志物,
检测饮酒后超过48小时。由于直到2011年才获得此类生物标志物,
最近,很少有研究将CM作为酒精使用障碍的治疗方法。在我们的初始资金中
期间,我们发现酒精生物标志物乙基葡萄糖醛酸苷(EtG)可以检测饮酒长达5天,
作为CM的随机12周试验的一部分施用。随机接受基于EtG的CM的患者为3次
更有可能提交酒精阴性EtG测试比对照。CM参与者也有较低水平的重
饮酒、使用兴奋剂和吸烟的人比对照组多。然而,CM对参与者无效
平均治疗前EtG水平表明频繁的、近期大量饮酒(EtG> 499 ng/mL)。我们
我建议调查两种策略-a)增加酒精含量或B)加强轻度饮酒
在加强禁欲之前-可以改善重度饮酒者的SMI结果。虽然最初的研究
表明这些策略与耐药药物使用者的治疗结果改善相关,
吸烟者,没有随机试验比较他们,调查他们在酒精使用者或成年人,
SMI,研究其相对成本效益,或使用理论
模型因此,我们将比较这两种方法与实施的CM干预的有效性。
重度饮酒者重度精神分裂症的初始资助期。共有400名参与者照常接受治疗,
治疗机构将参加为期4周的诱导期。达到平均EtG>的参与者(n = 240)
诱导期内499 ng/mL将随机分配至a)4个月的标准量级
用于提交戒酒EtG样品(EtG <100 ng/mL)的强化CM(微量CM),B)4个月
提交戒酒EtG样本的高幅度CM(高幅度CM),或c)1个月CM
提交酒精样本表明轻度饮酒(EtG <500 ng/mL),然后进行3个月的CM,
提交戒酒的EtG样本(Shaping CM)。主要结果将是EtG验证的酒精
在治疗的最后3个月内禁欲(当所有强化都取决于禁欲时),以及
在6个月的随访中。我们还将调查次要结局的组间差异,
CM条件的综合经济分析,并确定是否构成NIAAA的变量
成瘾神经临床评估框架在3 CM条件下中度戒酒。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Michael G McDonell其他文献
Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study
参与者对结核病预防治疗依从性和减少饮酒激励措施的看法:一项定性研究
- DOI:
10.1371/journal.pgph.0002472 - 发表时间:
2024 - 期刊:
- 影响因子:0
- 作者:
Ayesha Appa;Amanda P. Miller;Robin Fatch;Allen Kekibiina;Brian Beesiga;Julian Adong;N. Emenyonu;K. Marson;Monica Getahun;Moses R Kamya;W. Muyindike;Michael G McDonell;Harsha Thirumurthy;Judith A Hahn;G. Chamie;Carol S. Camlin - 通讯作者:
Carol S. Camlin
Michael G McDonell的其他文献
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{{ truncateString('Michael G McDonell', 18)}}的其他基金
Peth-Based Contingency Management to Reduce Alcohol Use and Improve Housing Outcomes
基于 Peth 的应急管理可减少饮酒并改善住房状况
- 批准号:
10016160 - 财政年份:2019
- 资助金额:
$ 68.17万 - 项目类别:
Native Center for Alcohol Research and Education
本土酒精研究和教育中心
- 批准号:
10310671 - 财政年份:2017
- 资助金额:
$ 68.17万 - 项目类别:
Novel EtG based Contingency Management for Alcohol in the Severely Mentally Ill
基于 EtG 的新型严重精神疾病患者酒精应急管理
- 批准号:
8441527 - 财政年份:2012
- 资助金额:
$ 68.17万 - 项目类别:
Novel EtG BasedContingency Management for Alcohol in the Severely Mentally Ill
基于 EtG 的新型严重精神疾病患者酒精应急管理
- 批准号:
10241354 - 财政年份:2012
- 资助金额:
$ 68.17万 - 项目类别:
Novel EtG based Contingency Management for Alcohol in the Severely Mentally Ill
基于 EtG 的新型严重精神疾病患者酒精应急管理
- 批准号:
8232535 - 财政年份:2012
- 资助金额:
$ 68.17万 - 项目类别:
Novel EtG BasedContingency Management for Alcohol in the Severely Mentally Ill
基于 EtG 的新型严重精神疾病患者酒精应急管理
- 批准号:
9761398 - 财政年份:2012
- 资助金额:
$ 68.17万 - 项目类别:
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