Citation

Oluwoye O, Skalisky J, Burduli E, Chaytor NS, McPherson S, Murphy S, Herron J, Hirchak K, Burley M, Ries RK, Roll JM, McDonell MG. Contemp. Clin. Trials 2018; 69: 92-98.

Affiliation

Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States. Electronic address: mmcdonell@wsu.edu.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.cct.2018.04.010

PMID

29680318

Abstract

BACKGROUND: In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG > 349 ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders. AIMS: To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative to those who receive typical low-magnitude abstinence based CM (Usual CM). Additionally, variables in the Addictions Neuroclinical Assessment model will be examined as treatment response moderators.

METHODS: Participants (N = 400) will be recruited from two urban mental health organizations and complete a 4-week induction periodwhere they will be reinforced for submitting samples for uEtG testing. Participants who attain a mean uEtG > 349 mg/mL will be randomized to receive either Usual CM, High-Magnitude CM, or Shaping CM for 16 weeks. Differences in abstinence, assessed by uEtG, will be examined during treatment and during a 12-month follow-up. Measures of negative emotionality, alcohol reinforcer salience, and executive functioning will be gathered at study intake and used to predict treatment outcomes.

DISCUSSION: This novel approach to CM will use an alcohol biomarker to identify those at risk for treatment non-response and determine if adaptations to CM might improve outcomes for this group.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Alcohol treatment; Contingency management; Ethyl glucuronide; Serious mental illness addictions neuroclinical assessment