Contingency Management for Alcohol Use Disorders

描述（由申请人提供）：应急管理（CM）治疗在改善药物滥用患者的结局方面非常有效。然而，CM很少被应用于酒精使用障碍的个人，主要是因为在监测饮酒的技术限制。安全连续远程酒精监测器（SCRAMx（R））是一项新技术，旨在每周7天，每天24小时连续监测酒精消耗量。该系统可能是理想的用于酒精使用障碍患者的CM试验。本研究的目的是评估CM在使用SCRAMx减少酒精使用方面的疗效。总共有120名在社区诊所开始门诊治疗的酒精滥用或依赖患者将被随机分配到两种情况之一：标准治疗，或标准治疗加CM，并根据SCRAMx读数的结果进行强化。研究干预将持续12周，在基线、治疗后和整个一年随访期间进行评估。所有参与者将在整个12周的研究期间佩戴SCRAMx监视器，作为酒精使用的客观指标，并在随访时再次佩戴。与标准治疗相比，我们预计CM将导致更少的饮酒天数和更长的连续非饮酒天数。我们还将评估CM对酒精结果的长期影响，我们假设治疗期间长时间不饮酒将导致整个随访期间饮酒率降低。此外，我们将探讨冲动与治疗结果的关联，以及冲动是否缓和或介导饮酒结果。CM还有望减少其他与酒精使用密切相关的药物使用和艾滋病毒风险行为。最后，我们将评估CM的成本效益和潜在成本效益。虽然这种治疗明显增加了成本，但它在减少饮酒方面可能比标准治疗更具成本效益，本研究将估计其可能具有成本效益的条件和患者人群。这项研究的结果对于将CM整合到酒精使用障碍的治疗中以及在临床试验中利用这项新技术铺平道路非常重要。

DESCRIPTION (provided by applicant): Contingency management (CM) treatments are highly efficacious in improving outcomes of substance abusing patients. However, CM has rarely been applied to individuals with alcohol use disorders, primarily because of technological limitations in monitoring drinking. The Secure Continuous Remote Alcohol Monitor (SCRAMx(R)) is a new technology designed to continuously monitor alcohol consumption 24 hours a day for 7 days per week. This system may be ideal for use in CM trials with patients with alcohol use disorders. The purpose of this study is to evaluate the efficacy of CM in reducing alcohol use using SCRAMx. In total, 120 alcohol abusing or dependent patients initiating outpatient treatment at community-based clinics will be randomly assigned to one of two conditions: standard care, or standard care plus CM with reinforcement based on results of SCRAMx readings. Study interventions will last for 12 weeks, with assessments conducted at baseline, post-treatment and throughout a one-year follow-up. All participants will wear SCRAMx monitors throughout the 12-week study period as an objective indicator of alcohol use, and again at follow-up. Compared with standard care, we expect that CM will result in fewer drinking days and longer durations of continuous non-drinking days. We will evaluate the long-term effects of CM on alcohol outcomes as well, and we hypothesize that long durations of non-drinking during the treatment period will result in lower rates of drinking throughout the follow-u period. In addition, we will explore the association of impulsivity with treatment outcomes, and whether impulsivity moderates or mediates drinking outcomes. CM is also expected to reduce other drug use and HIV risk behaviors, which are intricately linked with alcohol use. Finally, we will assess the cost-effectiveness and potential cost-benefits of CM. Although this treatment clearly adds costs, it may be more cost-effective in reducing drinking than standard care, and this study will estimate the conditions under which and patient populations for whom it may be cost effective. Results from this study will be important for paving the way toward integrating CM into treatment for alcohol use disorders and for utilizing this new technology in clinical trials.