Novel EtG Based Contingency Management for Alcohol in the Severely Mentally Ill We propose to conduct a randomized clinical trial investigating the effect of a 12-week ethyl glucuronide (EtG) urinalysis based contingency management (CM) intervention on decreasing alcohol use and increasing alcohol treatment attendance among persons with alcohol dependence (AD) and serious mental illness (SMI) receiving long-term community mental health treatment. While CM is an evidence-based treatment for illicit drug use, research regarding its efficacy for AD has been limited due to the absence of a pragmatic alcohol biomarker to base the CM paradigm upon. This study will include the novel application of EtG urine-tests, capable of detecting alcohol use for a two-day period similar to urine-tests of illicit drug use, on which most CM drug research has been based. EtG results will be utilized as both a research outcome and as a basis on which the CM intervention targeting alcohol use is based. In addition, the CM paradigm will include secondary reinforcement of attendance in intensive outpatient (IOP) addiction treatment. It is hypothesized that this secondary contingency will result in higher rates of IOP attendance. 120 AD-SMI adults will participate in a 4-week induction period (reinforcement for providing urinalysis three times a week). All participants will receive treatment as usual (TAU) for SMI and intensive outpatient (IOP) addiction treatment throughout the study. After an induction period participants will be randomized to receive either 1) 12 weeks of CM for alcohol abstinence (assessed 3 times a week by EtG urine-tests) AND weekly reinforcement for IOP addiction treatment attendance;or 2) 12 weeks of reinforcement for providing urine-tests 3 times a week. The primary outcome will be changes in alcohol use assessed by EtG urinalysis, breathalyzer, as well as self-reported and clinician-reported alcohol use. The secondary outcome will be changes in IOP addiction treatment attendance assessed by IOP clinician-report, as well as independent administrative data sources, and self-report. Other outcomes will include: biological measures of illicit drug use, self-reported illicit drug use, psychiatric symptoms, HIV-risk, nicotine use, and utilization f costly emergency department, inpatient psychiatric and residential addiction treatment services. All outcomes will be assessed across the 12-week intervention and a 3-month follow-up period. This proposed study addresses two public health priorities--alcohol use and poor treatment attendance--in a population of adults with SMI for whom these difficulties are especially prevalent and problematic;and is responsive to NIAAA PA-10-100, Alcohol Use Disorders: Treatment, Services Research, and Recovery (R01).

Public Health Relevance

Alcohol dependence disproportionately affects persons with co-occurring severe mental illnesses, such as schizophrenia, bipolar disorders, and chronic major depression, with consequences such as early treatment dropout, increased psychiatric hospitalization, psychiatric illness severity, HIV-risk, and nicotine use. This project proposes to evaluate a behavioral treatment, contingency management, that has strong support as a treatment for reducing drug use, but has been less researched as a treatment for alcohol use because of limitations of alcohol biomarkers, such as alcohol breath-tests. We propose to determine if a contingency management intervention that reinforces 1) alcohol abstinence, as assessed by the alcohol biomarker -ethyl glucuronide- and 2) outpatient alcohol treatment attendance results in reductions in alcohol use and increases in treatment attendance in 120 adults suffering from alcohol dependence and severe mental illness receiving treatment at an urban community mental health center.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
1R01AA020248-01A1
Application #
8232535
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Roach, Deidra
Project Start
2012-03-10
Project End
2015-02-28
Budget Start
2012-03-10
Budget End
2013-02-28
Support Year
1
Fiscal Year
2012
Total Cost
$347,344
Indirect Cost
$122,344
Name
University of Washington
Department
Psychiatry
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Oluwoye, Oladunni; Monroe-DeVita, Maria; Burduli, Ekaterina et al. (2018) Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study. Early Interv Psychiatry :
Oluwoye, Oladunni; Stiles, Bryan; Monroe-DeVita, Maria et al. (2018) Racial-Ethnic Disparities in First-Episode Psychosis Treatment Outcomes From the RAISE-ETP Study. Psychiatr Serv :appips201800067
Oluwoye, Oladunni; Leickly, Emily; Skalisky, Jordan et al. (2018) Serious Mental Illness in Heavy Drinkers Is Associated with Poor Treatment Outcomes in Outpatients with Co-occurring Disorders. Int J Ment Health Addict 16:672-679
Oluwoye, Oladunni; Hirchak, Katherine; Leickly, Emily et al. (2018) Interaction between pre-treatment drug use and heterogeneity of psychiatric diagnosis predicts outcomes in outpatients with co-occurring disorders. Psychiatry Res 260:233-235
Oluwoye, Oladunni; Skalisky, Jordan; Burduli, Ekaterina et al. (2018) Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness. Contemp Clin Trials 69:92-98
McPherson, Sterling M; Burduli, Ekaterina; Smith, Crystal Lederhos et al. (2018) A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Subst Abuse Rehabil 9:43-57
McDonell, Michael Gerard; Leickly, Emily; McPherson, Sterling et al. (2017) Pretreatment ethyl glucuronide levels predict response to a contingency management intervention for alcohol use disorders among adults with serious mental illness. Am J Addict 26:673-675
Leickly, Emily; Skalisky, Jordan; McPherson, Sterling et al. (2017) High Agreement Between Benchtop and Point-of-Care Dipcard Tests for Ethyl Glucuronide. Ther Drug Monit 39:461-462
McDonell, Michael G; West, Imara I; Ries, Richard K et al. (2017) Response to Urine Drug Testing in a Family Residency Practice. J Addict Med 11:243
Skalisky, Jordan; Leickly, Emily; Oluwoye, Oladunni et al. (2017) Prevalence and Correlates of Cannabis Use in Outpatients with Serious Mental Illness Receiving Treatment for Alcohol Use Disorders. Cannabis Cannabinoid Res 2:133-138

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