Effect of Incentives for Alcohol Abstinence in Partnership With 3 American Indian and Alaska Native Communities

Abstract

and Alaska Native communities are disproportionately affected by problems with alcohol use and seek culturally appropriate and effective interventions for individuals with alcohol use disorders.OBJECTIVE To determine whether a culturally tailored contingency management intervention, in which incentives were offered for biologically verified alcohol abstinence, resulted in increased abstinence among American Indian and Alaska Native adults. This study hypothesized that adults assigned to receive a contingency management intervention would have higher levels of alcohol abstinence than those assigned to the control condition. DESIGN, SETTING, AND PARTICIPANTSThis multisite randomized clinical trial, the Helping Our Native Ongoing Recovery (HONOR) study, included a 1-month observation period before randomization and a 3-month intervention period. The study was conducted at 3 American Indian and Alaska Native health care organizations located in Alaska, the Pacific Northwest, and the

Bringing Together Behavioral Science, Community Engagement, and Cultural Adaptations to Increase Alcohol Abstinence Among American Indian and Alaska Native People Using Contingency Management Therapy

“…Another notable strength of this research is the community-based participatory research approach taken. From using focus groups to constructing a community advisory board, the study design and implementation of the culturally adapted intervention were completed with community input and tribal oversight.…”

“…In this issue of JAMA Psychiatry , McDonell et al reported the results of a 12-week multisite randomized clinical trial of CM for the treatment of AUD among American Indian and Alaska Native adults in which rewards were provided for abstinence verified by ethyl glucuronide (EtG), a biomarker of recent alcohol use. Four hundred individuals were enrolled in a 4-week observation and qualification period in which they could receive treatment as usual and incentives for providing urine samples twice weekly for measurement of EtG.…”

“…The use of CM in the treatment of AUD has been hindered by the absence of a biomarker of alcohol use with a half-life that is not so short that it fails to detect recent use or so long that it precludes discerning recent abstinence. McDonell and colleagues have been leading research efforts examining whether EtG may be effective in that role. In this report, they have provided what is, to our knowledge, the most compelling evidence to date that CM using EtG is indeed efficacious at increasing alcohol abstinence, thereby further closing an important gap in the development of CM.…”

“…Of course, the study is not without limitations. The 4-week prerandomization period, in which 242 of 400 initially eligible patients (60.5%) were excluded, primarily for failing to attend at least half of twice-weekly urine monitoring appointments (n = 173), deserves comment.…”

“…Finally, the study does not discuss longer-term outcomes. Considering how little participants in either treatment condition availed themselves of treatment as usual and the modest empirical support for the outcomes of CM alone being sustained after incentives are discontinued, the possibility that the effects of this 12-week CM intervention will not be sustained in the longer term will need to be addressed.…”