Effectiveness and Outcomes of Combined Contingency Management and CBT for Alcohol Use Disorder

应急管理和 CBT 联合治疗酒精使用障碍的有效性和结果

• 批准号: 10529075
• 负责人: PATRICK S. CALHOUN
• 金额: $ 12.58万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10529075
• 关键词: Abstinence; Address; Afghanistan; Aftercare; Alcohols; Behavior Therapy; Behavioral; Caring; Cessation of life; Clinic; Cocaine; Cognitive Therapy; Data; Disease; Drug usage; FDA approved; Goals; Health Technology; Heavy Drinking; Incentives; Individual; Integrated Health Care Systems; Intervention; Iraq; Measures; Medical; Methamphetamine; Monitor; Morbidity - disease rate; Outcome; Outpatients; Patient Self-Report; Patients; Persons; Public Health; Quality-Adjusted Life Years; Randomized; Recording of previous events; Rewards; Secure; Substance Use Disorder; Substance abuse problem; United States; Veterans; Veterans Health Administration; alcohol abstinence; alcohol abuse therapy; alcohol misuse; alcohol monitoring; alcohol use disorder; comparative cost effectiveness; comparative effectiveness trial; contingency management; cost effective treatment; cost effectiveness; cost estimate; cost-effectiveness evaluation; cost-effectiveness ratio; design; diagnostic criteria; drug abstinence; effectiveness evaluation; effectiveness outcome; effectiveness testing; encryption; evidence base; follow-up; high risk drinking; implementation barriers; improved; incremental cost-effectiveness; innovation; mHealth; medical specialties; mortality; multidrug abuse; prevent; recruit; smartphone Application; standard care; stimulant use disorder; substance misuse; voucher

Alcohol contributes to 88,000 deaths and costs an estimated $223 billion annually in the United States. Alcohol use disorder (AUD) is highly prevalent in veterans; an estimated 32% of veterans meet diagnostic criteria for AUD. The positive public health impact of reducing heavy drinking among veterans with AUD would prevent significant medical morbidity and mortality. Behavioral incentives could increase treatment retention and increase abstinence among Veterans with AUD. Contingency management (CM) is an intensive behavioral therapy that provides incentives to individuals misusing substances. CM has demonstrated effect sizes beyond that of other behavioral treatments across multiple drugs of abuse, including a trial in Veterans with AUD, which demonstrated that CM both increased treatment retention and completion rates and was associated with increased abstinenence from alcohol compared to standard treatment. To date, however, implementation of CM interventions has largely focused on stimulant use disorders (e.g., cocaine; methamphetamine) due to the diffculty of monitoring abstinence from alcohol, which requires daily monitoring. Thus, despite demonstrated efficacy, CM aproaches for treatment of AUD are not currently available to people with AUD. Our group has developed a mobile smart-phone application that allows patients to video themselves using a small FDA-approved alcohol breath monitor and transmits the encrypted data to a secure server. This innovation has made the use of CM for outpatient AUD treatment feasible. Targeting AUD with mobile CM (mCM) paired with evidenced-based cognitive behavioral therapy (CBT) will significantly improve long-term abstinence rates and reduction in heavy drinking days among Veterans with AUD. The aim of the current study is to evaluate the effectiveness and cost effectiveness of contingency management as an adjunct to cognitive behavioral therapy for alcohol use disorders. The trial will also explore the potential utilty of a long-term abstinence incentive on treatment utilization and alcohol outcomes. Proposed is a comparative effectiveness trial with a 2 x 2 factorial design in which 160 Veterans with AUD will be proactively recruited and randomized to receive either CM as an adjunct to state-of-the-art evidenced-based CBT or CBT alone; and to one of two long-term incentive conditions (i.e., receipt of a monetery incentive for abstinence/low-risk drinking at 6- months vs. no incentive). This project aims to advance AUD treatment by 1) testing the effectiveness of a mobile health approach that makes CM for AUD feasible, and 2) providing highly needed cost-effectiveness data on the use of behavioral incentives as an adjunct to CBT for the treatment of AUD. These aims are designed to address two significant barriers to the implementation of efficacious CM for AUD.

酒精造成88,000人死亡，估计每年在美国造成2230亿美元。酒精 在退伍军人中，使用障碍（AUD）非常普遍；估计有32％的退伍军人符合AUD的诊断标准。 在使用AUD的退伍军人中减少大量饮酒的积极影响会预防重大 医疗发病率和死亡率。行为激励措施可以增加治疗保留率并增加禁欲 在带有澳元的退伍军人中。应急管理（CM）是一种强化行为疗法，提供 激励个人滥用物质。 CM表现出效果大小以外的效果大小 多种滥用药物的治疗，包括在AUD的退伍军人中进行的审判，这表明CM 既提高了治疗保留率和完成率，并且与戒酒的增加有关 与标准治疗相比，酒精。但是，迄今为止，CM干预的实施在很大程度上已 由于监测禁欲的难度 从酒精中，需要日常监控。因此，尽管证明了功效，但CM裂缝用于治疗 AUD目前尚不适用于AUD的人。我们的小组开发了一个移动智能手机应用程序 这使患者可以使用小型FDA批准的酒精呼吸监视器进行视频，并传输 将数据加密到安全服务器。这项创新使CM用于门诊AUD处理可行。 用移动CM（MCM）与基于证据的认知行为疗法（CBT）靶向AUD 有明显的提高了有AUD的退伍军人的长期禁欲和大量饮酒日的降低。 当前研究的目的是评估应急管理的有效性和成本效益 作为酒精使用障碍的认知行为疗法的辅助手段。审判还将探索潜在的UTILTY 长期禁止治疗利用和饮酒结果。提出的是比较 有效试验具有2 x 2阶乘设计，其中160名具有AUD的退伍军人将被主动招募，并且 随机将CM作为最先进的基于证据的CBT或CBT的辅助手段；一个 在两种长期激励条件（即，收到一次性戒酒/低风险饮酒的货币激励措施 几个月与没有激励）。该项目旨在通过1）测试手机的有效性来提高AUD治疗 使CM适合AUD可行的健康方法，以及2）在 将行为激励措施用作CBT治疗AUD的辅助措施。这些目标旨在解决 实施有效CM的两个重要障碍。