Pretreatment ethyl glucuronide levels predict response to a contingency management intervention for alcohol use disorders among adults with serious mental illness

Abstract

This study investigated if pretreatment ethyl glucuronide (EtG) levels corresponding to light (100ng/mL), heavy (500ng/mL), and very heavy (1,000ng/mL) drinking predicted longest duration of alcohol abstinence (LDA) and proportion of EtG-negative urine tests in 40 outpatients receiving a 12-week EtG-based contingency management (CM) intervention for alcohol dependence. Only the 500ng/mL cutoff was associated with significant differences in LDA and proportion of EtG-negative samples during CM. Those with a pre-treatment EtG<500ng/mL attained a LDA 2.3 (alcohol) to 2.9 (drugs) weeks longer than pre-treatment heavy drinkers. Results suggest pre-treatment EtG cutoffs equivalent to heavy and very heavy drinking predict outcomes in CM.

Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial

“…Overall, the results of the trial are mixed, and stand in contrast to the frequently positive benefits reported for CM interventions [15, 16], including for substance misuse in psychosis [17–19, 21]. Reasons for this are unclear; however, some possible explanations include the following: Firstly, offering more frequent CM sessions or offering a higher reward might have been more clinically effective.…”

“…A consistent finding of a benefit for CM was reported, with most studies using abstinence at 12 weeks as their outcome measure. In the context of severe mental illness, a number of trials have found CM to be effective in reducing use in patients with severe mental illness for alcohol [17], stimulant use [18], and cigarette smoking [19]. This includes one fairly recent trial of a 12-week CM intervention for stimulant misuse that found the treatment to be clinical and cost-effective [20].…”

Homelessness Predicts Attrition but Not Alcohol Abstinence in Outpatients Experiencing Co-Occurring Alcohol Dependence and Serious Mental Illness

“…In a previous analysis, we found that a mean pretreatment EtG level of >499 ng/mL (a cutoff level that identifies 78% of heavy drinking [>4 standard drinks] in the previous day) was the most powerful predictor of EtG-assessed abstinence in the intervention phase. 14 , 15 Therefore, we also controlled for preintervention drinking (EtG >499 or <500 ng/mL) in our analyses.…”

Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness

“…However, variables that differ between groups at baseline and during the induction phase will be used as covariates in subsequent analyses, as will baseline measures that co-vary with the outcome measures. This is a strategy of preliminary analysis that we and several other teams in the area of CM and addiction treatment have utilized for several decades [20,21,23,50–53]. …”

“…In a previous study of CM as a treatment for AUD in adults with SMI, we used the alcohol biomarker, urine ethyl glucuronide urine (uEtG) to assess abstinence. uEtG can detect use during the previous 2 days and heavy drinking up to 5 days after drinking [20,22,23]. CM participants were 3.1 times more likely to submit negative uEtG samples, relative to those receiving treatment-as-usual (TAU) and reinforcers for participation only [20].…”