Remote alcohol monitoring to facilitate abstinence reinforcement with an underserved population

项目摘要/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%到24% 有酒精使用障碍的人会寻求治疗。给出的最普遍的不寻求的理由 治疗涉及不能或不愿意(例如，由于羞辱)参加传统的面对面治疗 治疗。对于确实接受了酒精使用障碍治疗或护理的个人，他们的第一点是 与医学界的接触通常是为了戒酒。不幸的是，酗酒后复发 戒毒很常见，很少有人在出院后继续使用治疗服务。这个 酒精使用障碍的普遍存在表明需要继续开发高效果的治疗方法 是有效的，未经治疗的人可以接受的，并且很容易广泛传播。应急管理，或 根据已证实的戒酒情况给予金钱奖励是一种有效的酒精使用治疗方法 无序。然而，准确、频繁的生物化学验证戒酒的成本和障碍是有限的 这项技术在酒精使用障碍中的广泛应用。在我们的初步数据中，我们已经成功地 论证了远程酒精监测和鼓励减少酒精使用的可行性。我们 使用技术先进的移动酒精测试仪远程验证戒酒情况，手机 通信，以及可重新加载的借记卡，以提供激励措施，几乎没有延迟。我们的初步研究已经 这个模型显示出很高的禁酒率，参与者对这种方法给予了很高的评价 有效性和可接受性。在这里，我们将把这种模式发展成两种治疗方案，为 传播：1)针对戒酒启动和维持的独立远程治疗 服务不足的个人，以及2)现有治疗服务的辅助设施，以防止医院后复发 解毒。我们还将解决这两种治疗背景下的其他知识差距：1)什么是 戒烟激励的最大有效持续时间和强度是什么，以及2)治疗的持久性是什么 一旦停止激励措施，就会产生影响。通过使用结合在一起的技术进步 通过禁欲激励的新方法，拟议的研究有可能为 为大量酒精使用障碍患者带来有效的循证治疗 目前因现有的治疗选择而得不到足够的服务，或者在以下情况下无法维持戒酒 解毒。由于自动化程度和研究人员执行的相对较低，这一点 治疗模型具有高度的可扩展性，这是解决未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.