Contingency management is among the more effective strategies for promoting abstinence in the treatment of substance use disorders. Contingency management programs are designed to reinforce target behaviors (e.g., a negative urine drug screen) by delivering a tangible reward when the target behavior occurs, and withholding the reward when the target behavior does not occur. Historically, the application of contingency management to the treatment of alcohol use disorders has been limited by reliance on breath alcohol tests – typically administered in outpatient treatment settings – as the primary measure of alcohol use. Given the short half-life of breath alcohol, breath alcohol tests will not detect drinking beyond a relatively brief period. One approach that can address the limitations of other objective measures of recent alcohol use is transdermal alcohol monitoring, which provides a continuous measure of alcohol excreted through the skin.
[Photo: Dr. Nancy Barnett]
The purpose of this study, led by Dr. Nancy Barnett, professor of behavioral and social sciences and faculty member in the Center for Alcohol and Addiction Studies, was to test the efficacy of daily contingent reinforcement for reducing alcohol use using a transdermal alcohol sensor to detect alcohol use. Heavy drinking adults not seeking treatment were randomized to three weeks of (1) an escalating schedule of cash reinforcement for days on which alcohol was neither reported or detected, or (2) a noncontingent reinforcement condition. Reinforcement for those in the contingency condition started at $5 and increased $2 every subsequent day on which alcohol was not detected or reported, to a maximum of $17.
The researchers found that those in the contingent reinforcement condition has higher percent days with no drinking detected (54.3 percent) than the noncontingent reinforcement condition (31.2 percent) during intervention weeks. Four times more participants in the contingent condition drank below the National Institutes of Health low-risk drinking guidelines during the intervention than did participants in the noncontingent condition. After one-month of follow up, the highest self-reported number of consecutive days without drinking did not differ between the conditions, but showed a medium effect size.
This study demonstrated clinically meaningful behavior change among heavy drinking participants using continuous alcohol monitoring as a contingency measure. This represents a step forward in exploring new ways to promote abstinence in those with alcohol use disorders.
This study was published in Addiction (ahead of print).
For more information: https://www.ncbi.nlm.nih.gov/pubmed/28107772