Novel EtG based Contingency Management for Alcohol in the Severely Mentally Ill

基于 EtG 的新型严重精神疾病患者酒精应急管理

• 批准号: 8232535
• 负责人: Michael G McDonell
• 金额: $ 34.73万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-10 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8232535
• 关键词: Accident and Emergency department; Address; Adult; Affect; Alcohol consumption; Alcohol dependence; Alcohols; Behavior Therapy; Behavioral; Biological; Biological Markers; Bipolar Disorder; Breath Tests; Chronic; Communities; Community Mental Health Centers; Data Sources; Detection; Dropout; Drug usage; Early treatment; Ensure; Evidence based treatment; Funding; Glucuronides; Goals; HIV; HIV Infections; Health; Health Services Research; Homelessness; Hospitalization; Hour; Illicit Drugs; Individual; Ingestion; Inpatients; Intervention; Major Depressive Disorder; Measurement; Measures; Mental Health; Mentally Ill Persons; Monitor; National Institute on Alcohol Abuse and Alcoholism; Nature; Nicotine; Outcome; Outcomes Research; Outpatients; Participant; Patient Self-Report; Persons; Pharmaceutical Preparations; Population; Psychiatric therapeutic procedure; Psychological reinforcement; Public Health; Publishing; Randomized; Randomized Clinical Trials; Recovery; Relapse; Reporting; Research; Risk; Risk Behaviors; Schizophrenia; Services; Severities; Severity of illness; Symptoms; Testing; Time; United States National Institutes of Health; Urinalysis; Urine; addiction; alcohol abstinence; alcohol abuse therapy; alcohol use disorder; base; behavioral impairment; breath alcohol measurement; contingency management; drug craving; drug of abuse; experience; follow-up; high risk; improved; innovation; novel; post intervention; primary outcome; psychostimulant; public health priorities; reduced alcohol use; reinforcer; secondary outcome; severe mental illness; therapy design; treatment as usual

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：基于ETG的新型饮酒的新型意外事件在严重的精神疾病中，我们建议进行一项随机临床试验，研究基于12周的基于12周的乙基葡萄糖醛酸乙基葡萄糖醛酸乙酯（ETG）尿液分析的影响，基于尿液分析的意外事件管理（CM）干预对降低酒精饮酒的人的酒精治疗以及对酒精依赖的人的酒精治疗疗法的患者治疗患者的患者的养护（AD）和严重的精神疾病（AD）和SMI（SMI）和SMI（SMI）（SMI）。尽管CM是用于非法药物使用的循证治疗方法，但由于缺乏务实的酒精生物标志物来基于CM范式，因此有关其AD功效的研究受到限制。这项研究将包括ETG尿液测试的新型应用，能够在两天的时间内检测到与非法药物使用的尿液测试相似的两天，大多数CM药物研究都基于该药物。 ETG结果将被用作研究结果，也将用作针对饮酒的CM干预的基础。此外，CM范式将包括次要入学率（IOP）成瘾治疗中的次要加强。假设这种次要的偶然性将导致IOP出勤率更高。 120名AD-SMI成年人将参加为期4周的入选期（加强尿液分析三倍 星期）。在整个研究中，所有参与者都将照常接受SMI和强化门诊（IOP）成瘾治疗的治疗。在诱导期之后，将随机分配参与者1）戒酒的12周CM（每周通过ETG尿液测试评估3次）和每周的iop成瘾治疗出勤加强；或2）每周3次提供尿液测试的12周加固。主要结果是通过ETG尿液分析，呼吸分析以及自我报告和临床医生报告的酒精使用评估的酒精使用变化。次要结果将是IOP临床医生报告评估的IOP成瘾治疗出勤的变化，独立的行政数据源和自我报告。其他结果将包括：非法药物使用，自我报告的非法药物使用，精神病症状，艾滋病毒危，尼古丁的使用和利用率F昂贵的急诊科，住院精神病患者和住宅成瘾治疗服务。所有结果将在整个12周的干预措施和3个月的随访期内进行评估。这项拟议的研究涉及两个公共卫生优先事项 - 饮酒和治疗差 - 在有SMI的成年人中，这些困难尤其普遍且有问题。并且对NIAAA PA-10-100，酒精使用障碍：治疗，服务研究和恢复（R01）。 公共卫生相关性：酒精依赖性不成比例地影响患有严重精神疾病的患者，例如精神分裂症，双相情感障碍和慢性重大抑郁症，以及诸如早期治疗，精神病医院住院，精神病患病的疾病严重程度，HIV危机，HIV风险和尼古丁的后果。这个项目提议 评估一种行为治疗，即应急管理，该治疗方法是减少药物使用的一种治疗方法，但由于酒精生物标志物（例如酒精呼吸测试）的限制而被研究为饮酒的治疗方法较少。我们建议确定加强强化的应急管理干预措施是否通过酒精生物标志物 - 乙基葡萄糖醛酸乙糖剂和2）饮酒的戒烟来减少酒精使用量的降低，并增加了120名因酒精依赖和应对严重的精神疾病治疗的饮酒活动而增加的治疗率，而接受了严重的精神疾病。