Contingency Management for Alcoholism

(Peth Trial)

Overseen By Ruth Fetter

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: UConn Health

Disqualifiers: Condition hindering participation

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

Compensation: Varies

Number of Visits: 4

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method to help people with alcohol use disorders using contingency management (CM), which rewards participants for attending treatment and not drinking. The study will compare two groups: one receiving standard care with CM and the other receiving standard care only. Researchers expect the CM group to show better results, such as more non-drinking days and fewer heavy drinking days, over a year-long follow-up. Individuals in outpatient treatment diagnosed with an alcohol use disorder might be a good fit for this trial. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could improve treatment options for alcohol use disorders.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that contingency management (CM) is a well-researched treatment for substance use problems, including alcohol use. Studies have found that participants generally find CM easy to handle. In one study, CM effectively reduced alcohol dependence without major safety issues. A review of CM for various substance use problems found no serious side effects, suggesting it is safe for participants.

CM uses rewards to encourage positive actions, like staying sober, which can improve treatment outcomes. Decades of research support the safety of CM, demonstrating long-term benefits without significant harm. Participants in past studies have not reported serious negative effects from CM, indicating it is a safe choice for those considering joining a clinical trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard care for alcoholism, which often involves therapy and medication like naltrexone or acamprosate, contingency management introduces a unique approach by using positive reinforcement to encourage sobriety. Researchers are excited about this method because it directly incentivizes healthy behavior changes, offering tangible rewards for maintaining abstinence. This approach has the potential to enhance motivation and treatment adherence, which are often challenges in traditional care. By focusing on immediate, positive outcomes, contingency management could provide a more engaging and effective treatment pathway for individuals struggling with alcoholism.

What evidence suggests that this trial's treatments could be effective for alcohol use disorders?

Research has shown that contingency management (CM) effectively treats alcohol use problems. One study found that 69% of people who received CM stayed sober, compared to 39% who did not. In this trial, participants in the experimental group will receive standard care plus CM, which uses rewards to encourage positive actions, such as attending treatment sessions and maintaining sobriety. This method has improved treatment outcomes for substance use issues. Recent advancements even allow CM to be provided remotely, increasing accessibility. Overall, CM is a proven method to help reduce alcohol use and improve quality of life. ^{2 3 6 7 8}

Who Is on the Research Team?

Sheila Alessi, Ph.D.

Principal Investigator

UConn Health

Are You a Good Fit for This Trial?

This trial is for individuals with an alcohol use disorder who are starting intensive outpatient treatment. It's not suitable for those with conditions that could interfere with their participation in the study.

Inclusion Criteria

You have been diagnosed with a drinking problem by a mental health professional.

I am currently in a rigorous outpatient treatment program.

Exclusion Criteria

You have a medical condition that may make it difficult for you to participate in the study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive outpatient treatment for alcohol use disorders with PEth monitoring every 3 weeks for 12 weeks. Participants are assigned to either standard care or standard care plus contingency management.

12 weeks

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with a focus on alcohol abstinence and group attendance.

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Contingency management
• Standard care

Trial Overview The study tests if adding a reward system (Contingency Management) to standard care improves attendance and reduces alcohol consumption in patients. Participants will either receive standard care or standard care plus rewards for attending treatment and providing alcohol-free blood samples.

How Is the Trial Designed?

Group I: Experimental Group Experimental Treatment 2 Interventions

Standard care plus contingency management

Group II: Control Group Active Control 1 Intervention

Standard care

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

Approved in United States as Contingency Management for:

• Alcohol dependence
• Substance use disorders

Approved in European Union as Contingency Management for:

• Alcohol dependence
• Substance use disorders

Who Is Running the Clinical Trial?

UConn Health

Lead Sponsor

Trials

218

Recruited

59,100+

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Collaborator

Trials

865

Recruited

1,091,000+

Published Research Related to This Trial

Contingency management (CM) effectively uses positive reinforcement to enhance treatment outcomes for substance abusers, particularly in achieving sustained abstinence from drugs.

CM is not only beneficial as a direct therapeutic approach but also serves as a valuable tool in clinical trials for testing new medications and improving patient adherence to treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management: utility in the treatment of drug abuse disorders. Stitzer, ML., Vandrey, R.[2019]

Contingency management (CM) interventions have been shown to effectively increase physical activity and medication adherence in various medical conditions, based on a review of 24 randomized studies.

The positive effects of CM tend to diminish once the reinforcement is removed, indicating the need for ongoing support to maintain these health behavior changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Ellis, JD., Struble, CA., Fodor, MC., et al.[2021]

A group-based contingency management (CM) intervention for HIV-positive patients with cocaine or opioid use disorders led to significantly more consecutive drug-free urine samples compared to a 12-step (TS) group, indicating its effectiveness in promoting abstinence during treatment.

CM participants also experienced greater reductions in viral loads and HIV-risk behaviors from pre- to post-treatment, although these benefits were not sustained in the long term, highlighting the need for further research to enhance lasting outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group-based randomized trial of contingencies for health and abstinence in HIV patients. Petry, NM., Weinstock, J., Alessi, SM., 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]

Contingency management (CM) interventions have been shown to consistently improve treatment outcomes for substance abuse, but they are rarely used in practice due to various concerns.

The article reviews common criticisms of CM, including philosophical, motivational, durability, and economic issues, and suggests ways to address these concerns to enhance the implementation of this effective treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management treatment for substance use disorders: How far has it come, and where does it need to go? Petry, NM., Alessi, SM., Olmstead, TA., et al.[2019]

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]

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]

Contingency management (CM) is a culturally acceptable and feasible approach for treating alcohol use disorders among American Indian and Alaska Native (AI/AN) communities, emphasizing the need for culturally specific and practical reinforcers like art supplies and transportation assistance.

The success of the CM intervention is enhanced when it is supported by respected community members, such as Elders, and incorporates local language and cultural symbols, aligning with AI/AN values and practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Focus groups to increase the cultural acceptability of a contingency management intervention for American Indian and Alaska Native Communities. Hirchak, KA., Leickly, E., Herron, J., et al.[2020]

The cost to set up a contingency management (CM) program for treating patients with severe alcohol use disorder and serious mental illness is approximately $6,038 per site, with average treatment costs ranging from $1,119 to $1,865 per participant over 16 weeks depending on the CM version used.

This study provides a customizable costing tool that helps treatment providers estimate expenses associated with different CM designs, which can aid in budgeting and sustaining CM interventions in their practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Budget Impact Tool for Implementing Contingency Management for Co-occurring Alcohol Use Disorders and Serious Mental Illness. Lu, TT., Parent, SC., Chaytor, N., et al.[2023]

Contingency management (CM) has been effectively implemented at a large U.S. Department of Veterans Affairs Addiction Treatment Center to encourage abstinence from substance use, highlighting its role as an evidence-based intervention.

The implementation faced challenges such as staff acceptance, initial referral limitations, and the need for proper training and resources, but local innovations have helped expand CM since its introduction in 2012.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of Contingency Management at a Large VA Addiction Treatment Center. Ruan, H., Bullock, CL., Reger, GM.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6760431/

Contingency Management: Incentives for Sobriety - PMC By the end of the treatment period, 69 percent of the patients in the contingent group had not yet experienced a relapse to alcohol use, compared with 39 ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5714694/

Contingency management treatment for substance use ... Contingency management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT01567943

Contingency Management of Alcohol Abuse in the ... The investigators will evaluate the efficacy of a comprehensive 12-week contingency management intervention for treating alcohol dependence for persons with ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S2772724623000100

Feasibility study findings of an app-based contingency ... Contingency Management (CM) is among the most effective interventions for AUD, with recent technological advancements allowing CM to be provided remotely.

5. 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) ...

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

A review of contingency management for the treatment ... A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies,

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8034391/

Long-Term Efficacy of Contingency Management ... CM showed long-term benefit in reducing objective indices of drug use, above and beyond other active, evidence-based treatments (e.g., cognitive–behavioral ...

8. 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, ...