Contingency Management for Alcoholism

(ARMS II Trial)

Overseen By Abigail L Bowen, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Washington State University

Disqualifiers: Severe alcohol use disorder, Dangerous withdrawal, Suicide attempt, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 45 months

125 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a method called Contingency Management (CM), which uses rewards to help people reduce or quit drinking alcohol. The researchers aim to determine if this approach effectively decreases alcohol consumption among adults motivated to change their drinking habits. Participants divide into two groups: one receives increasing rewards for positive behavior, while the other gets a flat amount for participation. Ideal candidates are adults who have experienced several heavy drinking occasions in the past month, have a smartphone, and want to cut down on alcohol. As an unphased trial, this study offers participants the chance to contribute to innovative research that could lead to new methods for reducing alcohol consumption.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Contingency Management is safe for reducing alcohol consumption?

Research has shown that Contingency Management (CM) is generally safe for treating substance use disorders. CM uses rewards to encourage positive actions, such as staying sober. Studies have found that this method is well-received, with few reports of negative effects.

Researchers have tested CM in different settings and with various groups, finding it effective in reducing substance use without causing harm. The approach focuses on providing positive feedback, which many find motivating and easy to manage.

While CM is primarily used for substance use disorders, researchers are also exploring its application for other issues, such as alcohol use. The treatment's safety in other areas supports its use here as well. Overall, CM is considered a safe and promising method for those seeking to reduce alcohol consumption. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about contingency management for alcoholism because it offers a different approach compared to traditional treatments like counseling or medication. This method focuses on positive reinforcement, rewarding individuals for reducing their alcohol consumption. Unlike standard options, which often rely on therapy or medication to curb cravings or manage withdrawal, contingency management provides tangible rewards for maintaining sobriety. This approach could potentially motivate individuals to stick with their treatment plans and see quicker results in reducing alcohol intake.

What evidence suggests that Contingency Management is effective for reducing alcohol consumption?

Research has shown that Contingency Management (CM) effectively treats various substance use problems. CM uses rewards to motivate behavioral change. Studies have found that this method can help individuals reduce or quit using substances, including alcohol. Over 30 years of research supports its success in helping people remain substance-free and improve their lives. In this trial, one group will receive CM to help reduce alcohol use by offering more rewards for positive actions, even if initial results aren't perfect. Another group will receive a non-contingent management approach, where participants receive a flat amount for submitting samples on time, without an increasing scale for maintaining samples at 0.00% BAC. ^{1 2 3 4 6}

Who Is on the Research Team?

Sterling M McPherson, PhD

Principal Investigator

Washington State University

Are You a Good Fit for This Trial?

This trial is for adults who are looking to quit or cut down on their alcohol consumption. The specific eligibility criteria have not been provided, but typically participants must meet certain health conditions and agree to follow the study's procedures.

Inclusion Criteria

Have the ability to provide written informed consent

Have consumed 3 or more drinks in once occasion 4 or more times in the previous 30 days

Have a breath alcohol value of 0.00 during informed consent

Exclusion Criteria

I am 71 years old or older.

Individuals who do not test BrAC = 0.00 on the breathalyzer during the baseline visit

Individuals who express concern regarding dangerous withdrawal or who exhibit dangerous withdrawal symptoms

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in Contingency Management (CM) treatment, submitting breathalyzer samples and receiving rewards based on results.

45 months

Daily remote submissions, weekly calls, monthly clinic visits

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Contingency Management

Trial Overview

The ARMS II study is testing a behavioral treatment called Contingency Management (CM) which rewards individuals for meeting sobriety goals. It's a non-medicated approach in a randomized controlled setting to see if it helps reduce alcohol intake.

How Is the Trial Designed?

Group I: Contingency Management + Treatment As Usual Experimental Treatment 1 Intervention

An experimental approach examining the effectiveness of contingency management for promoting a decrease in drinking through increasing rewards for positive behavior. Participants will be given positive reinforcement messaging regardless of the sample's results.

Group II: Non-Contingent Management + Treatment As Usual Active Control 1 Intervention

Participants will be given a flat amount for submitting samples on time, and there is no increasing scale for maintaining samples at 0.00%BAC. Participants will be given positive reinforcement messaging regardless of the sample's results.

Contingency Management is already approved in United States, European Union for the following indications:

Approved in United States as Contingency Management for:

• Substance Use Disorders
• Stimulant Use Disorder
• Methamphetamine Use Disorder

Approved in European Union as Contingency Management for:

• Substance Use Disorders
• Addiction Treatment

Who Is Running the Clinical Trial?

Washington State University

Lead Sponsor

Trials

114

Recruited

58,800+

Managed Health Connections

Collaborator

Trials

1

Recruited

130+

Published Research Related to This Trial

A survey of 214 substance use treatment providers revealed that while many clinics are using reward programs, they often do not follow effective practices recommended by research, such as providing higher reward amounts or immediate reinforcement.

Providers with more extensive training in contingency management (CM) were more likely to implement effective strategies, suggesting that better training could improve the quality of reward-based interventions in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining implementation of contingency management in real-world settings. Rash, CJ., Alessi, SM., Zajac, K.[2021]

In a 16-week study involving 12 cocaine-dependent methadone patients, cash-based incentives of $50 and $100 significantly increased short-term cocaine abstinence compared to a control condition with no incentives.

The study found that cash-based incentives did not lead to increased cocaine use after receiving the incentives, suggesting they are a safe option for improving treatment outcomes in substance abuse interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. Vandrey, R., Bigelow, GE., Stitzer, ML.[2022]

In a study involving 142 outpatients with cocaine or heroin dependence, both voucher and prize-based contingency management (CM) interventions led to longer treatment retention and greater durations of confirmed abstinence compared to standard treatment.

While there were no significant differences in abstinence rates at 6- and 9-month follow-ups, the duration of abstinence achieved during treatment was the strongest predictor of continued abstinence after treatment ended.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vouchers versus prizes: contingency management treatment of substance abusers in community settings. Petry, NM., Alessi, SM., Marx, J., et al.[2016]

In a study involving 74 cocaine-dependent methadone outpatients over 12 weeks, both voucher and prize-based contingency management (CM) interventions led to longer durations of abstinence compared to standard treatment.

The study found no significant differences in outcomes between the voucher and prize systems, indicating that both methods are effective in promoting abstinence during treatment, which is linked to better long-term recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. Petry, NM., Alessi, SM., Hanson, T., et al.[2021]

A portable contingency management (CM) system using cellphones and breathalyzers was tested with 30 adults, showing that 88.6% of breath alcohol concentration (BrAC) tests were submitted on time, indicating high feasibility for this method.

Participants receiving CM had a higher percentage of negative BrAC results and longer durations of abstinence, along with reduced drinking frequency and related problems, demonstrating the initial efficacy of this approach in addressing alcohol use issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. Alessi, SM., Petry, NM.[2022]

In a study of 42 alcohol-dependent veterans, those who received contingency management (CM) alongside standard treatment had a much higher retention rate in treatment (84%) compared to those receiving only standard treatment (22%).

By the end of the 8-week treatment period, 69% of CM participants remained abstinent from alcohol, while 61% of those in standard treatment had relapsed, indicating that CM is an effective strategy for promoting abstinence in alcohol treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Give them prizes, and they will come: contingency management for treatment of alcohol dependence. Petry, NM., Martin, B., Cooney, JL., et al.[2022]

A study involving 120 cocaine-abusing outpatients showed that a low-cost prize reinforcement contingency management (CM) intervention significantly increased abstinence rates, especially in patients receiving up to $240 in potential rewards compared to standard treatment.

Patients who started treatment with positive urine tests responded best to the CM intervention, indicating that the effectiveness of prize reinforcement may depend on the severity of the patient's condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prize reinforcement contingency management for treating cocaine users: how low can we go, and with whom? Petry, NM., Tedford, J., Austin, M., et al.[2018]

In a 12-week study involving 161 adults with alcohol dependence, higher-magnitude contingency management (CM-H) significantly reduced the average number of positive breath samples, indicating less alcohol use during the intervention.

Participants in the CM-H group had a higher rate of abstinence during follow-up, suggesting that home-based CM with sufficient incentives can effectively support long-term abstinence from alcohol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home-Based Contingency Management Delivered by Community Health Workers to Improve Alcohol Abstinence: A Randomized Control Trial. Jirapramukpitak, T., Pattanaseri, K., Chua, KC., et al.[2020]

A systematic review of 12 randomized controlled trials involving 1654 adults found that adding cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET) to contingency management (CM) did not improve rates of abstinence from substance use at the end of treatment or during follow-up.

The analysis showed no significant benefits in secondary outcomes, such as self-reported days of substance use, indicating that CM alone is as effective as when combined with these psychotherapeutic interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. Sheridan Rains, L., Steare, T., Mason, O., et al.[2021]

Citations

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pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6095117/

A review of contingency management for the treatment ...

Introduction. Contingency management (CM) is an effective behavioral treatment approach commonly applied to substance-use disorders (SUDs).

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recoveryanswers.org

recoveryanswers.org/resource/contingency-management/

Contingency Management (CM)

Contingency Management is often called motivational incentives, the prize method, or the carrot and stick method.

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pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC12280170/

Financial Incentives for Substance Abstinence

Financial incentives (FI) are a promising tool to promote health behavior change, including substance abstinence. We aim to address a 10-year gap in the ...

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library.samhsa.gov

library.samhsa.gov/sites/default/files/contingency-management-advisory-pep24-06-001.pdf

contingency-management-advisory-pep24-06-001.pdf

Contingency management (CM) is a proven health care intervention with demonstrated effectiveness in treating a variety of substance use disorders (SUDs) ...

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aspe.hhs.gov

aspe.hhs.gov/sites/default/files/documents/a0cc6fcdb2968be95f60bb1c2c94eb70/contingency-management-sub-treatment.pdf

Contingency Management for the Treatment of Substance ...

CM has three decades of research demonstrating its long-term efficacy for treating a variety of SUDs, including stimulant, opioid, cannabis, ...

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pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10330855/

Implementing an evidence-based prize contingency ...

This article provides planning stage guidance to support programs' adoption of evidence-based prize CM for the treatment of stimulant use disorders.