A Financially Sustainable Remote Treatment for Alcohol Abuse: Feasibility

经济上可持续的酒精滥用远程治疗：可行性

• 批准号: 8970165
• 负责人: Mikhail Nikolaas Koffarnus
• 金额: $ 24.76万
• 依托单位: VIRGINIA POLYTECHNIC INST AND ST UNIV
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8970165
• 关键词: Abstinence; Accounting; Address; Adult; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; Biochemical; Cigarette; Conscious; Contracts; Country; Deposition; Development; Devices; Dimensions; Disease; Drug abuse; Evidence based treatment; Feasibility Studies; Financial cost; Funding; Incentives; Individual; Internet; Intervention; Knowledge; Location; Measures; Methodology; Modeling; Monitor; Online Systems; Participant; Persons; Phase; Population; Procedures; Psychological reinforcement; Publishing; Randomized; Reporting; Research; Rural; Sampling; Secure; Smoker; Techniques; Technology; Time; Travel; Treatment Cost; United States; alcohol abstinence; alcohol abuse therapy; alcohol content; alcohol monitoring; contingency management; cost; cost effective; craving; effective therapy; interest; meetings; new technology; novel; payment; prevent; public health relevance; reduced alcohol use; tool

 DESCRIPTION (provided by applicant): Nearly 18% of United States adults meet criteria for alcohol dependence sometime in their lifetime, with only 24% of those individuals ever receiving any treatment for their disorder. Nearly 30% of people who meet criteria for alcohol abuse or dependence have considered seeking treatment, but have not done so. The pervasiveness of alcohol dependence indicates a need for continued development of high-impact treatments that are both effective and easily disseminated to a broad population. Contingency management, or the delivery of monetary incentives contingent on verified abstinence, is an effective treatment for drug and alcohol abuse. However, the cost of incentive payments for abstinence and technological barriers to accurate, frequent biochemical verification of alcohol abstinence limit the use of this technique for the treatment of alcohol dependence. Deposit contracts, where the participant contributes to their own incentive fund up front, have been shown to reduce or eliminate incentive costs in similar treatments. Also, a breathalyzer has recently been developed with technological features that make it ideally suited for use in a contingency management intervention. This breathalyzer has the capacity to remotely verify abstinence from alcohol and contains a number of features to verify the identity of the user and prevent tampering. In the present application, we propose to use deposit contracts and this breathalyzer to facilitate a contingency-management intervention to reduce alcohol use that requires no in-person contact between the participants and the study staff during the intervention phase and is cost effective. To this end, we propose two specific aims. First, we will determine the feasibility of remotely-delivered contingency management trial to reduce alcohol use by using technological advances to overcome barriers in treatment delivery. We will conduct a randomized, controlled two-group feasibility study with a Contingent and Noncontingent group. The Contingent group will provide a deposit and then receive nearly immediate monetary payments over the internet each day they remotely provide negative breathalyzer samples. The Noncontingent group will also provide a deposit and receive payments each day they successfully provide samples independent of the alcohol content of those samples. Our first Specific Aim is to determine whether the contingency management intervention reduces alcohol use in the Contingent group to a greater extent than the Noncontingent group. In our second Specific Aim, we will assess participant ratings of acceptability and usefulness of these novel technologies. Poor ratings of acceptability or usefulness may suggest challenges of compliance and further dissemination. As potential treatment vehicles, it is important to assess whether the various technological tools and procedures used in this feasibility trial are viewed as effective and acceptable among individuals who are interested in reducing or ceasing their alcohol use. Together these specific aims will allow us to determine if remote, verified alcohol monitoring combined with deposit contracts is an effective treatment for alcohol dependence that is well accepted by participants.

 描述（由申请人提供）：近18%的美国成年人在一生中的某个时候符合酒精依赖标准，其中只有24%的人接受过任何酒精依赖治疗。近30%符合酒精滥用或依赖标准的人曾考虑寻求治疗，但没有这样做。酒精依赖的普遍性表明，需要继续开发既有效又易于向广大人群传播的高效治疗方法。应急管理，或根据经核实的戒酒情况提供金钱奖励，是治疗吸毒和酗酒的有效办法。然而，戒酒奖励金的成本以及对戒酒进行准确、频繁的生物化学验证的技术障碍限制了这种技术在治疗酒精依赖方面的应用。存款合同，即参与者预先向自己的激励基金缴款，在类似的处理中已被证明可以减少或消除激励成本。此外，最近开发了一种呼气测醉器，其技术特征使其非常适合用于应急管理干预。该呼气测醉器能够远程验证戒酒情况，并包含许多功能来验证用户身份并防止篡改。在本申请中，我们提出使用存款合同和该呼气测醉器来促进应急管理干预以减少酒精使用，其在干预阶段期间不需要参与者和研究工作人员之间的亲自接触并且是成本有效的。为此，我们提出两个具体目标。首先，我们将确定远程提供应急管理试验的可行性，以通过利用技术进步来克服治疗提供中的障碍，从而减少酒精使用。我们将进行一项随机、对照的两组可行性研究，包括应急组和非应急组。应急小组将提供一个存款，然后通过互联网收到几乎立即货币付款，每天他们远程提供负呼气测醉器样本。非特遣队小组还将提供存款，并收到付款，每天他们成功地提供样品独立于这些样品的酒精含量。我们的第一个具体目标是确定应急管理干预是否在更大程度上减少酒精使用的应急组比非应急组。在我们的第二个具体目标中，我们将评估参与者对这些新技术的可接受性和实用性的评分。可接受性或有用性评级不佳可能表明在遵守和进一步传播方面存在挑战。作为潜在的治疗工具，重要的是要评估在这项可行性试验中使用的各种技术工具和程序是否被认为是有效的，并在有兴趣减少或停止使用酒精的个人中被接受。这些具体目标将使我们能够确定远程、经验证的酒精监测与存款合同相结合是否是受试者广泛接受的酒精依赖的有效治疗方法。