Remote alcohol monitoring to facilitate abstinence reinforcement with an underserved population

远程酒精监测有助于服务不足的人群加强戒酒

• 批准号: 10015192
• 负责人: Mikhail Nikolaas Koffarnus
• 金额: $ 65.88万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10015192
• 关键词: Abstinence; Address; Adult; Alcohol consumption; Alcohols; Area; Automation; Biochemical; Caring; Cellular Phone; Clinical; Clinical Services; Communication; Communities; Control Groups; DSM-V; Data; Development; Drug Metabolic Detoxication; Effectiveness; Evidence based treatment; Goals; Health; Health Personnel; Hospitals; Incentives; Individual; Inpatients; Intervention; Knowledge; Lead; Maintenance; Medical; Modeling; Participant; Persons; Population; Prevalence; Prize; Psychological reinforcement; Randomized; Relapse; Research; Services; Severities; Stigmatization; System; Techniques; Testing; Underserved Population; United States; alcohol abstinence; alcohol monitoring; alcohol services; alcohol use disorder; base; contingency management; cost; disorder later incidence prevention; effective therapy; experimental study; feasibility trial; financial incentive; interest; novel; outpatient programs; prevent; readmission rates; recruit; secondary analysis; treatment as usual; treatment effect; treatment services

PROJECT SUMMARY/ABSTRACT Lifetime prevalence of DSM-5 alcohol use disorder in the United States is 29%, but only 20 to 24% of people with alcohol use disorder ever seek treatment. The most prevalent reasons given for not seeking treatment relate to an inability or unwillingness (e.g., due to stigmatization) to attend traditional in-person treatment. For individuals who do receive medical treatment or care for alcohol use disorder, their first point of contact with the medical community is often for alcohol detoxification. Unfortunately, relapse following alcohol detoxification is common and few people continue utilizing treatment services after being discharged. The pervasiveness of alcohol use disorder indicates a need for continued development of high-impact treatments that are effective, acceptable to the untreated, and easily disseminated widely. Contingency management, or the delivery of monetary incentives contingent on verified abstinence, is an effective treatment for alcohol use disorder. However, costs and barriers to accurate, frequent biochemical verification of alcohol abstinence limit the widespread use of this technique for alcohol use disorder. In our preliminary data, we’ve successfully demonstrated the feasibility of remote alcohol monitoring and incentives for the reduction of alcohol use. We used technologically advanced mobile breathalyzers to verify abstinence remotely, cell phones for communication, and a reloadable debit card to deliver incentives with little delay. Our preliminary study has shown a high rate of abstinence with this model and participants gave this approach high ratings for effectiveness and acceptability. Here, we will develop this model into two treatment options ready for dissemination: 1) a stand-alone remote treatment directed toward abstinence initiation and maintenance in underserved individuals, and 2) an adjunct to existing treatment services to prevent relapse after hospital detoxification. We will also address additional gaps in knowledge in both treatment contexts: 1) what the maximally effective duration and intensity of abstinence incentives is, and 2) what the persistence of treatment effects are once incentives are discontinued. Through the use of technological advancements combined in a novel way with abstinence incentives, the proposed research has the potential to provide a framework for bringing effective, evidence-based treatments to a large number of individuals with alcohol use disorder who are currently underserved by existing treatment options or are unable to maintain abstinence after detoxification. Due to the extent of automation and relatively low use of research staff to execute, this treatment model is highly scalable, an important feature when addressing the large problem of untreated alcohol use disorder.

项目摘要/摘要 美国DSM-5饮酒障碍的终生患病率为29％，但只有20％至24％ 酒精疾病的人寻求治疗。 治疗涉及无关或不愿意（例如，由于污名化）参加传统的面对面 治疗的人。 与医学界的接触通常用于酒精排毒。 排毒很常见，很少有人在出院后继续使用治疗服务。 酒精使用障碍的普遍性表明需要继续发展高影响治疗 有效，可以接受的未经处理，并且很容易被广泛传播。 货币激励措施取决于验证的禁欲，是对酒精使用的有效待遇 然而，疾病的成本和频率频繁的生化验证的成本和障碍 在我们的预放数据中，thechnique的广泛使用。 证明了远程酒精监测的可行性和对我们使用酒精的激励措施 使用技术先进的移动呼吸圈子来远程验证节制，手机 沟通和可重新加载的借记卡，几乎没有延迟提供激励措施。 显示出高度与模型的禁欲，参与者给予了这种方法的高评级评级 有效性和可接受性。 传播：1）针对禁欲和维护的独立远程处理 服务不足的人，以及2）现有治疗服务的辅助手段，以防止医院后复发 排毒。 最大有效的持续时间和禁欲激励措施的强度是2）治疗的个性 对激励措施的影响是通过使用技术来脱颖而出的。 戒酒激励措施的新颖方式，支撑的研究有可能为框架提供框架 将有效的，基于证据的治疗治疗带给大量的患有饮酒障碍的人 目前是底面选项，或者之后无法保持节制 由于自动化的程度和研究人员的相对使用程度。 处理模型是高度可扩展的，这是解决未经治疗问题的重要特征 酒精使用障碍。