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
• 负责人: Michael G McDonell
• 金额: $ 21.12万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016160
• 关键词: Abstinence; Administrator; Adult; Alcohol abuse; Alcohol consumption; Alcohols; Behavior Therapy; Biological; Biological Markers; Blood; Blood specimen; Breath Tests; Charities; Clinical; Detection; Development; Drops; Employment; Fingers; Glucuronides; Homelessness; Hour; Housing; Impairment; Imprisonment; Incentives; Individual; Intervention; Lipids; Maintenance; Measures; Medical Care Costs; Mental Health; Methods; Modeling; Monitor; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Phase; Provider; Psychological reinforcement; Public Health; Qualitative Methods; Randomized; Reinforcement Schedule; Sampling; Site; Spottings; Testing; Time; Treatment Efficacy; Urine; Work; alcohol abstinence; alcohol monitoring; alcohol use disorder; base; breath alcohol measurement; contingency management; design; effective intervention; effectiveness implementation study; effectiveness implementation trial; experience; experimental study; follow-up; high risk population; implementation science; improved; incentive-based intervention; minimally invasive; phosphatidylethanol; physical conditioning; post intervention; prevent; primary outcome; programs; randomized trial; recruit; reduced alcohol use; reinforcer; residential tenure; severe mental illness; supported housing; therapy design; therapy development; treatment as usual

ABSTRACT Nearly 40% of homeless adults currently struggle with an alcohol use disorder (AUD). While “housing first” programs are increasingly available, most homeless people must refrain from alcohol use to obtain and maintain housing. Contingency management (CM) is one of the most effective behavioral interventions for initiating abstinence from alcohol and drugs. In a randomized trial of CM for AUDs in adults with co-occurring serious mental illness, 60% of whom were homeless, we found that those who received CM were 3 times more likely to submit alcohol-negative urine ethyl glucuronide tests (uEtG), relative to controls. However, homeless individuals were 8 times more likely to drop out of CM, relative to housed individuals. Therefore, CM appears to work best for those who are housed. By using CM to reduce alcohol use in formerly homeless individuals who are now housed, CM might prevent subsequent alcohol-associated homelessness. The brief periods of detection of uEtG (2-5 days) and other alcohol biomarkers require monitoring of abstinence multiple times a day (breath tests) or week (uEtG) in a CM intervention. Such frequent monitoring is not feasible in most housing programs or necessary once individuals obtain prolonged periods of abstinence. Phosphatidylethanol (PEth) is a lipid-based biomarker that can detect alcohol use for up to 28 days. The lengthy detection period of PEth would allow for a more feasible monitoring and reinforcement schedule (e.g. 1 assessment every 1 to 4 weeks) and allows for the development of a CM intervention that can reinforce maintenance of long-term abstinence (e.g., monitoring and reinforcement once every 4 weeks). We propose to assess the feasibility and initial efficacy of a PEth-based CM intervention by randomizing 50 currently housed, formerly homeless adults with AUDs receiving supported housing from Catholic Charities Spokane. Participants will be randomized to either 6 months of a) treatment-as- usual (TAU) and reinforcers for submitting blood samples, regardless of PEth results (Non-contingent Control), or b) TAU and reinforcers for PEth results consistent with abstinence (CM). They will then complete a 3-month post-intervention follow-up. Our CM intervention will include 2 phases. In the initiation phase, PEth samples will be collected and reinforcers delivered weekly until individuals attain a PEth level consistent with prolonged abstinence (i.e., PEth 16:0/18:1 <20 ng/mL). CM participants will then enter the maintenance phase where they will submit less frequent PEth samples, 1 sample every 2 to 4 weeks. In this treatment development study, we will simultaneously evaluate intervention acceptability and feasibility using quantitative and qualitative methods and initial efficacy by documenting differences in alcohol abstinence, housing tenure and alcohol associated harms. We will use the Theoretical Domains Framework to guide our assessment of factors that might influence implementation of the intervention. Results will be used to support an R01 application to conduct a multi-site hybrid effectiveness/implementation trial to determine the impact of the intervention on alcohol use, housing outcomes, and alcohol related harms, as well as assess implementation science outcomes.

摘要 近40%的无家可归成年人目前正与酒精使用障碍(AUD)作斗争。而“住屋为先” 项目越来越多，大多数无家可归者必须戒酒才能获得和维持 住房。应急管理(CM)是最有效的行为干预手段之一 戒酒戒毒。在一项CM治疗成人AUDS的随机试验中 精神疾病，其中60%无家可归，我们发现那些接受CM治疗的人患精神疾病的可能性是对照组的3倍 提交酒精阴性的尿乙基葡萄糖醛酸苷试验(UEtG)，与对照组相比。然而，无家可归的人 与居住的人相比，退出CM的可能性高出8倍。因此，CM似乎工作得最好 对于那些住在房子里的人。通过使用CM来减少以前无家可归的人现在是 有了房子，CM可能会防止随后与酒精相关的无家可归现象。UEtG的短暂检测周期 (2-5天)和其他酒精生物标志物需要一天多次监测戒酒(呼气测试)或 每周(UEtG)在CM干预中。这种频繁的监测在大多数住房项目中是不可行的或 一旦个人获得长时间的禁欲，就有必要这样做。磷脂酰乙醇(PEH)是一种以脂类为基础的 生物标志物，可以检测酒精使用长达28天。Peth较长的检测期将允许 更可行的监测和增援时间表(例如，每1至4周进行一次评估)，并允许 开发可加强长期戒酒维持的CM干预措施(例如，监测和 每4周加固一次)。我们建议评估基于PEHS的CM的可行性和初步疗效 通过随机选择50名目前居住的、以前无家可归的成年人进行干预，这些成年人的AUDS得到了支持 来自天主教慈善机构斯波坎的住房。参与者将随机接受6个月的治疗-AS-AS- 通常(TAU)和补强剂，用于提交血样，而不考虑PETS结果(非或有控制)， 或b)与禁欲结果一致的TAU和增强剂(CM)。然后他们将完成为期3个月的 干预后随访。我们的CM干预将包括两个阶段。在启动阶段，佩斯样品将 每周收集和提供增强剂，直到个人达到与延长的佩斯水平一致 禁欲(即16：0/18：1&lt；20 ng/mL)。CM参与者随后将进入维护阶段，在此阶段他们 将提交频率较低的PESS样本，每2至4周提交1个样本。在这项治疗发展研究中，我们 将使用定量和定性方法同时评估干预的可接受性和可行性 通过记录戒酒、住房保有期和与酒精相关的差异来记录最初的疗效 伤害。我们将使用理论领域框架来指导我们对可能影响的因素的评估 实施干预措施。结果将用于支持R01应用程序进行多站点 混合有效性/实施试验，以确定干预对酒精使用、住房的影响 结果，以及与酒精有关的危害，以及评估实施科学成果。