A Financially Sustainable Remote Treatment for Alcohol Abuse: Feasibility

 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的标准，其中只有24%的人曾接受过任何治疗。近30%的符合酒精滥用或依赖标准的人曾考虑寻求治疗，但尚未这样做。酒精依赖的普遍存在表明，需要继续开发既有效又容易传播给广大人口的高影响治疗方法。应急管理是一种有效的治疗药物和酒精滥用的方法，也就是根据已证实的戒酒情况提供货币奖励。然而，戒酒的奖励费用，以及对戒酒进行准确、频繁的生化验证的技术障碍，限制了这项技术用于治疗酒精依赖。存款合同，即参与者预先向自己的激励基金缴款，已被证明在类似的待遇中可以减少或消除激励成本。此外，最近开发出了一种酒精测定仪，其技术特征使其非常适合用于应急管理干预。这种酒精测定仪具有远程验证戒酒的能力，并包含许多功能来验证用户的身份和防止篡改。在本申请中，我们建议使用存款合同和这种酒精测定器来促进应急管理干预，以减少酒精使用，这种干预不需要参与者和研究人员在干预阶段进行面对面接触，而且具有成本效益。为此，我们提出了两个具体目标。首先，我们将确定远程交付应急管理试验的可行性，通过利用技术进步来克服提供治疗的障碍来减少酒精使用。我们将对临时和非临时小组进行随机、对照的两组可行性研究。应急小组将提供一笔押金，然后几乎立即通过互联网收到付款，他们每天远程提供阴性酒精测试样本。非偶然性小组还将提供押金和付款，他们成功提供样本的每一天都与这些样本的酒精含量无关。我们的第一个具体目标是确定应急管理干预是否比非应急组在更大程度上减少了应急组的酒精使用。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有用性的评级。可接受性或有用性的低评级可能意味着遵守和进一步传播方面的挑战。作为潜在的治疗工具，重要的是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有兴趣减少或停止饮酒的个人视为有效和可接受的。这些具体目标加在一起，将使我们能够确定远程、经核实的酒精监测与存款合同相结合是否是被参与者很好地接受的酒精依赖的有效治疗方法。

 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.