Peth-Based Contingency Management to Reduce Alcohol Use and Improve Housing Outcomes

基于 Peth 的应急管理可减少饮酒并改善住房状况

• 批准号: 10016160
• 负责人: Michael G McDonell
• 金额: $ 21.12万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016160
• 关键词: Abstinence; Administrator; Adult; Alcohol abuse; Alcohol consumption; Alcohols; Behavior Therapy; Biological; Biological Markers; Blood; Blood specimen; Breath Tests; Charities; Clinical; Detection; Development; Drops; Employment; Fingers; Glucuronides; Homelessness; Hour; Housing; Impairment; Imprisonment; Incentives; Individual; Intervention; Lipids; Maintenance; Measures; Medical Care Costs; Mental Health; Methods; Modeling; Monitor; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Phase; Provider; Psychological reinforcement; Public Health; Qualitative Methods; Randomized; Reinforcement Schedule; Sampling; Site; Spottings; Testing; Time; Treatment Efficacy; Urine; Work; alcohol abstinence; alcohol monitoring; alcohol use disorder; base; breath alcohol measurement; contingency management; design; effective intervention; effectiveness implementation study; effectiveness implementation trial; experience; experimental study; follow-up; high risk population; implementation science; improved; incentive-based intervention; minimally invasive; phosphatidylethanol; physical conditioning; post intervention; prevent; primary outcome; programs; randomized trial; recruit; reduced alcohol use; reinforcer; residential tenure; severe mental illness; supported housing; therapy design; therapy development; treatment as usual

ABSTRACT Nearly 40% of homeless adults currently struggle with an alcohol use disorder (AUD). While “housing first” programs are increasingly available, most homeless people must refrain from alcohol use to obtain and maintain housing. Contingency management (CM) is one of the most effective behavioral interventions for initiating abstinence from alcohol and drugs. In a randomized trial of CM for AUDs in adults with co-occurring serious mental illness, 60% of whom were homeless, we found that those who received CM were 3 times more likely to submit alcohol-negative urine ethyl glucuronide tests (uEtG), relative to controls. However, homeless individuals were 8 times more likely to drop out of CM, relative to housed individuals. Therefore, CM appears to work best for those who are housed. By using CM to reduce alcohol use in formerly homeless individuals who are now housed, CM might prevent subsequent alcohol-associated homelessness. The brief periods of detection of uEtG (2-5 days) and other alcohol biomarkers require monitoring of abstinence multiple times a day (breath tests) or week (uEtG) in a CM intervention. Such frequent monitoring is not feasible in most housing programs or necessary once individuals obtain prolonged periods of abstinence. Phosphatidylethanol (PEth) is a lipid-based biomarker that can detect alcohol use for up to 28 days. The lengthy detection period of PEth would allow for a more feasible monitoring and reinforcement schedule (e.g. 1 assessment every 1 to 4 weeks) and allows for the development of a CM intervention that can reinforce maintenance of long-term abstinence (e.g., monitoring and reinforcement once every 4 weeks). We propose to assess the feasibility and initial efficacy of a PEth-based CM intervention by randomizing 50 currently housed, formerly homeless adults with AUDs receiving supported housing from Catholic Charities Spokane. Participants will be randomized to either 6 months of a) treatment-as- usual (TAU) and reinforcers for submitting blood samples, regardless of PEth results (Non-contingent Control), or b) TAU and reinforcers for PEth results consistent with abstinence (CM). They will then complete a 3-month post-intervention follow-up. Our CM intervention will include 2 phases. In the initiation phase, PEth samples will be collected and reinforcers delivered weekly until individuals attain a PEth level consistent with prolonged abstinence (i.e., PEth 16:0/18:1 <20 ng/mL). CM participants will then enter the maintenance phase where they will submit less frequent PEth samples, 1 sample every 2 to 4 weeks. In this treatment development study, we will simultaneously evaluate intervention acceptability and feasibility using quantitative and qualitative methods and initial efficacy by documenting differences in alcohol abstinence, housing tenure and alcohol associated harms. We will use the Theoretical Domains Framework to guide our assessment of factors that might influence implementation of the intervention. Results will be used to support an R01 application to conduct a multi-site hybrid effectiveness/implementation trial to determine the impact of the intervention on alcohol use, housing outcomes, and alcohol related harms, as well as assess implementation science outcomes.

抽象的 目前，近40％的无家可归的成年人患有酒精使用障碍（AUD）。而“首先” 计划越来越可用，大多数无家可归的人必须避免使用酒精才能获得和维护 住房。应急管理（CM）是启动最有效的行为干预措施之一 酒精和毒品的禁欲。在CM的随机试验中，在同时发生的成年人的AUD中 精神疾病，其中60％是无家可归的，我们发现那些收到广告的人的可能性高3倍 相对于对照组，提交酒精阴性的尿乙基糖乙酰胺试验（UETG）。但是，无家可归的人 相对于住所个人，退出广告的可能性高出8倍。因此，广告似乎最好 对于那些被住的人。通过使用CM减少以前无家可归的人的饮酒 安置的CM可能会阻止随后与酒精相关的无家可归者。 UETG的短期检测 （2-5天）和其他酒精生物标志物需要每天多次监测节制（呼气测试）或 CM干预中的周（UETG）。在大多数住房计划或 一旦个人长期戒酒时期，就需要必要。磷脂酰乙醇（Peth）是一种基于脂质的 可以检测到酒精饮酒长达28天的生物标志物。 Peth的长度检测期将允许 更可行的监控和加固时间表（例如，每1至4周评估1评估），并允许 开发CM干预措施，该干预措施可以增强长期禁欲的维持（例如，监测和 每4周加固一次）。我们建议评估基于Peth的商业的可行性和初始效率 通过随机安置的50个随机进行干预，以前是无家可归的成年人，获得了支持的AUDS 来自天主教慈善机构斯波坎的住房。参与者将被随机分为6个月a）治疗 - 通常（tau）和增强剂用于提交血液样本，无论peth结果如何（非固定控制）， 或b）tau和peth的增强剂与戒酒（CM）一致。然后他们将完成3个月 干预后随访。我们的CM干预将包括2个阶段。在主动阶段，Peth样品将 收集并每周交付增强剂，直到个人达到peth级别与延长一致 禁欲（即Peth 16：0/18：1 <20 ng/ml）。 CM参与者将进入他们的维护阶段 将较少提交Peth样本，每2至4周一次样本。在这项治疗开发研究中，我们 只需使用定量和定性方法评估干预的可接受性和可行性 通过记录戒酒，住房任期和酒精相关的差异来初步效率 危害。我们将使用理论领域框架来指导我们对可能影响因素的评估 干预的实施。结果将用于支持R01应用程序以进行多站点 混合有效性/实施试验，以确定干预对饮酒的影响，住房 结果和与酒精有关的危害以及评估实施科学成果。