Remote alcohol monitoring to facilitate abstinence reinforcement with an underserved population

项目总结/摘要 在美国，DSM-5酒精使用障碍的终生患病率为29%，但只有20%至24%的人患有这种疾病。 有酒精使用障碍的人会寻求治疗。不寻求的最普遍的理由 治疗涉及不能或不愿意（例如，由于污名化）亲自参加传统的 治疗对于那些接受酒精使用障碍治疗或护理的人，他们的第一点 与医学界的接触往往是为了戒酒。不幸的是，酗酒后复发 戒毒很普遍，很少有人在出院后继续使用治疗服务。的 酒精使用障碍的普遍性表明需要继续开发高效治疗方法 有效的、未治疗者可接受的、易于广泛传播的药物。应急管理，或 根据经核实的戒酒情况提供金钱奖励，是治疗酒精使用的有效方法 disorder.然而，成本和障碍，以准确，频繁的生化验证酒精戒断的限制 这种技术在酒精使用障碍中的广泛应用。在我们的初步数据中，我们成功地 这表明了远程酒精监测和减少酒精使用激励措施的可行性。我们 使用技术先进的移动的呼气测醉器来远程验证禁欲， 通信，和一个rebellion借记卡，以提供奖励，几乎没有延迟。我们的初步研究 显示了高比例的禁欲与此模型和参与者给这种方法的高评级， 有效性和可接受性。在这里，我们将把这个模型发展成两种治疗方案， 传播：1）一个独立的远程治疗，针对禁欲开始和维持， 服务不足的个人，以及2）现有治疗服务的辅助，以防止住院后复发 解毒我们还将解决两种治疗背景下的其他知识差距：1） 戒烟激励的最大有效持续时间和强度，以及2）治疗的持续性 一旦激励措施停止，效果就会消失。通过使用技术进步结合在一个 新的方式与禁欲激励，拟议的研究有可能提供一个框架， 为大量酒精使用障碍患者提供有效的循证治疗， 目前现有的治疗方案服务不足，或无法在 解毒由于自动化程度和相对较低的使用研究人员来执行， 治疗模型是高度可扩展的，这是解决未经治疗的大问题时的一个重要特征。 酒精使用障碍

PROJECT SUMMARY/ABSTRACT Lifetime prevalence of DSM-5 alcohol use disorder in the United States is 29%, but only 20 to 24% of people with alcohol use disorder ever seek treatment. The most prevalent reasons given for not seeking treatment relate to an inability or unwillingness (e.g., due to stigmatization) to attend traditional in-person treatment. For individuals who do receive medical treatment or care for alcohol use disorder, their first point of contact with the medical community is often for alcohol detoxification. Unfortunately, relapse following alcohol detoxification is common and few people continue utilizing treatment services after being discharged. The pervasiveness of alcohol use disorder indicates a need for continued development of high-impact treatments that are effective, acceptable to the untreated, and easily disseminated widely. Contingency management, or the delivery of monetary incentives contingent on verified abstinence, is an effective treatment for alcohol use disorder. However, costs and barriers to accurate, frequent biochemical verification of alcohol abstinence limit the widespread use of this technique for alcohol use disorder. In our preliminary data, we’ve successfully demonstrated the feasibility of remote alcohol monitoring and incentives for the reduction of alcohol use. We used technologically advanced mobile breathalyzers to verify abstinence remotely, cell phones for communication, and a reloadable debit card to deliver incentives with little delay. Our preliminary study has shown a high rate of abstinence with this model and participants gave this approach high ratings for effectiveness and acceptability. Here, we will develop this model into two treatment options ready for dissemination: 1) a stand-alone remote treatment directed toward abstinence initiation and maintenance in underserved individuals, and 2) an adjunct to existing treatment services to prevent relapse after hospital detoxification. We will also address additional gaps in knowledge in both treatment contexts: 1) what the maximally effective duration and intensity of abstinence incentives is, and 2) what the persistence of treatment effects are once incentives are discontinued. Through the use of technological advancements combined in a novel way with abstinence incentives, the proposed research has the potential to provide a framework for bringing effective, evidence-based treatments to a large number of individuals with alcohol use disorder who are currently underserved by existing treatment options or are unable to maintain abstinence after detoxification. Due to the extent of automation and relatively low use of research staff to execute, this treatment model is highly scalable, an important feature when addressing the large problem of untreated alcohol use disorder.