Piloting Deposit Contracts to Increase Accessibility of a Contingency Management Intervention to Reduce Problematic Drinking

试行押金合同，以提高应急管理干预的可及性，从而减少饮酒问题

• 批准号: 10640054
• 负责人: Donald M Dougherty
• 金额: $ 21.47万
• 依托单位: UNIVERSITY OF NORTH TEXAS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10640054
• 关键词: Alcohol abuse; Alcohol consumption; Alcohols; Attitude; Back; Behavior; Body Weight decreased; Caring; Chronic; Client; Clinic Visits; Consumption; Contracts; Dangerousness; Deposition; Devices; Effectiveness; Electronics; Enrollment; Ethics; Funding; Goals; Grant; Health; Heavy Drinking; Incentives; Individual; Intervention; Intervention Studies; Investments; Monitor; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Perception; Persons; Pilot Projects; Preparation; Procedures; Public Health; Randomized; Remote management; Reporting; Research; Rewards; Site; Specific qualifier value; Strategic Planning; Substance abuse problem; Time; Translating; Translations; Travel; Validation; Visit; Weight; Work; alcohol misuse; alcohol monitoring; contingency management; cost; cost estimate; drinking; economic cost; effective intervention; fitbit; incentive-based intervention; innovation; interest; intervention cost; meetings; monitoring device; mortality; novel; payment; prevent; programs; recruit; response; sensor; social stigma

Project Summary/Abstract Problem drinking is a leading cause of preventable morbidity and mortality in the US, with high economic cost; however, effective interventions often remain inaccessible. In response, this R21 application proposes to translate our previously developed incentive-based intervention into a sustainable, easily accessible intervention using remote alcohol monitoring and deposit contracts, targeting individuals who would not be reached by more traditional forms of treatment due to barriers such as time constraints, attitudes, and stigma. Incentive-based interventions are highly effective and overcome many of these barriers and can be attractive to people not seeking more formal treatment for their substance abuse. Previously we demonstrated that one such incentive-based intervention (i.e., contingency management) providing weekly payments based on remote alcohol monitoring effectively reduces dangerous drinking. However, contingency management interventions like ours remain largely inaccessible due three widely held concerns: (1) objectively detecting alcohol consumption is difficult (which we have overcome with remote alcohol monitoring); (2) providing incen- tives makes contingency management expensive; and (3) contingency management is viewed by some as ethically questionable, because it rewards clients for not engaging in behaviors they should not pursue anyway. To alleviate these concerns, we propose using deposit contracts. With deposit contracts: (a) individuals invest their own money, which is earned back if a specified goal (or contingency) is met; and (b) remote alcohol monitoring and electronic payment, obviate frequent clinic visits. Like contingency man- agement, deposit contracts provide incentives for the absence of problem drinking, but incentives come from participants themselves. Deposit contracts are less expensive than contingency management and reduce eth- ical objections by having participants reward themselves for reducing problematic drinking. This proposed pilot study will explore the feasibility of deposit contracts by recruiting heavy-drinking individuals into a deposit contract intervention aimed at reducing their problem drinking (Aim 1) and develop evidence of deposit contract effectiveness and cost-neutrality (Aim 2). Such an intervention would reduce barriers that limit accessibility (such as cost, time, and travel) and ethical concerns. This project is timely, since over a dozen companies are developing “Fitbit”-style alcohol monitoring devices, many of which are now undergoing pilot and validation work in preparation for consumer use (we are a site independently validating one such device). The work proposed will demonstrate feasibility, provide initial evidence of effectiveness, and lay the groundwork for a much larger study of an intervention that could be made widely accessible for reducing problem drinking in a novel and sustainable manner.

项目摘要/摘要 饮酒问题是美国可预防的发病率和死亡率的主要原因，经济高昂 成本;但是，有效的干预措施通常仍然无法访问。作为回应，此R21申请提案 将我们先前开发的基于激励的干预措施转化为可持续，易于访问的 使用远程酒精监控和存款合同的干预，针对不会 由于时间限制，出席和污名等障碍，以更传统的治疗形式达到。 基于激励的干预措施非常有效，并克服了许多障碍，可以是 对于不寻求对毒品滥用的人们寻求更正式治疗的人有吸引力。以前我们证明了 这样的基于激励的干预措施（即应急管理）提供基于每周付款的 在远程酒精监测时，有效地减少了危险的饮酒。但是，应急管理 由于三个广泛关注的问题，像我们这样的干预措施在很大程度上仍然无法访问：（1）客观地检测 饮酒很困难（我们通过远程酒精监测来克服）； （2） Tives使应急管理昂贵； （3）某些人认为应急管理 从道德上有疑问，因为它奖励客户不参与他们不应该追求的行为 反正。为了减轻这些问题，我们建议使用存款合同。与存款合同：（a） 个人投资自己的钱，如果达到特定的目标（或应急），这将获得回报； （b） 远程酒精监控和电子支付，经常避免临床访问。像偶然性的man- 装备，存款合同为缺乏饮酒提供激励措施，但激励措施来自 参与者自己。存款合同比应急管理便宜，并减少ETH- 通过让参与者减少饮酒的问题来奖励自己。 这项拟议的试点研究将通过招募大量饮酒来探索存款合同的可行性 个人进入旨在减少问题饮酒的存款合同干预措施（AIM 1）并发展 存款合同有效性和成本中性的证据（AIM 2）。这样的干预会减少 限制可访问性（例如成本，时间和旅行）和道德问题的障碍。这个项目是及时的， 由于多家公司正在开发“ Fitbit”风格的酒精监测设备，其中许多现在正在 进行试点和验证工作以准备消费者使用（我们是一个独立验证的网站 一个这样的设备）。提出的工作将证明可行性，提供有效性的初始证据，并 为更大的干预研究奠定了基础，该研究可以广泛访问 以新颖而可持续的方式减少饮酒的问题。