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.
Directly reinforcing abstinence from alcohol with monetary incentives is an effective treatment for alcohol dependence, but financial cost and barriers to obtaining frequent, verified biochemical measures of abstinence limit the dissemination of this treatment approach. We will conduct a feasibility study to determine if using participant-supplied deposit contracts and technological advancements to remotely, accurately, and securely monitor alcohol use with a newly developed breathalyzer will be an effective treatment that is acceptable to participants. If validated, this treatment approach has the potential to facilitate te dissemination of a cost- effective, potent, evidence-based treatment for alcohol dependence to a broader population of individuals motivated for treatment, many of whom are do not currently receive treatment.
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