Experiences with SCRAMx alcohol monitoring technology in 100 alcohol treatment outpatients

Abstract

Background Transdermal alcohol monitoring technology allows for new research on alcohol use disorders. This study assessed feasibility, acceptability, and adherence with this technology in the context of two clinical research trials. Methods Participants were the first 100 community-based alcohol treatment outpatients enrolled in randomized studies that monitored drinking with the secure continuous remote alcohol monitor (SCRAMx®) for 12 weeks. Study 1 participants were randomized to usual care (n=36) or usual care with contingency management incentives for treatment attendance (CM-Att; n=30). Study 2 participants were randomized to usual care (n=17) or usual care with CM for each day of no drinking per SCRAMx (CM-Abst; n=17). After 12 weeks, participants completed a survey about the bracelet. Results Nine percent of individuals screened (54 of 595) declined participation because of the bracelet. Of participants, 84% provided 12 weeks of data, and 96% of bracelets were returned fully intact. Ninety-four equipment tampers occurred, affecting 2% of monitoring days; 56% (67) of tampers coincided with detected drinking. Common concerns reported by participants were skin marks (58%), irritation (54%), and interfered with clothing choices (51%), but severity ratings were generally mild (60%-94%). Eighty-one percent of participants reported that the bracelet helped them reduce drinking, and 75% indicated that they would wear it for longer. A common suggestion for improvement was to reduce the size of the bracelet. Conclusions Results support the viability of transdermal monitoring in voluntary substance abuse treatment participants for an extended duration. Issues to consider for future applications of this technology are discussed.

Assessment of Alcohol Use in the Natural Environment

“…TAS field studies have been conducted in various populations, including college students and young adults (e.g., Luczak et al., ; Neville et al., ), treatment‐seeking (e.g., Barnett et al., ), and non–treatment‐seeking heavy drinkers recruited from the community (Dougherty et al., ,b), outpatients from alcohol treatment facilities (Alessi et al., ), and adults recently arrested for driving under the influence of alcohol (e.g., Mathias et al., ). Investigations using WrisTAS have typically involved wearing the device for 1 to 2 weeks (Luczak et al., ; Marques and McKnight, ; Simons et al., ).…”

“…One study using WrisTAS reported that 6% of college student participants failed to consistently wear the sensor (Luczak et al., ), and another study involving students found that the sensor was removed on approximately 10% of all study days (Simons et al., ). In a clinical sample using SCRAM devices, 34% of participants tampered with the sensor, and 56% of these tamper events were linked to drinking (Alessi et al., ).…”

“…The most common complaints reported in studies using SCRAM have been discomfort, interference with physical activities, and stigma associated with device usage (Alessi et al., ; Barnett et al., , ; Sakai et al., ). Approximately 9% of an alcohol outpatient treatment sample refused study participation due to the bracelet (Alessi et al., ). Treatment‐seeking heavy drinkers reported noticing the device approximately once per hour during waking and twice per night during sleep (Barnett et al., ).…”

Wearable electrochemical alcohol biosensors

“…The concentration of alcohol permeating through the epidermis in this manner can be detected by wearable devices, termed transdermal sensors, and has exhibited validated correlations against BrAC and BAC (Figure 1A) [44–46]. Several sensing platforms utilizing this method of alcohol monitoring have been developed with most clinical reports focusing on two devices: the Secure Continuous Remote Alcohol Monitor from Alcohol Monitoring Systems, Inc. (SCRAM™; Figure 4A); and the Wrist Transdermal Alcohol Sensor from Giner Inc. (WrisTAS™; Figure 4B) [46–48]. The SCRAM™ is designed as an ankle bracelet with a sensor compartment and a digital signal processing compartment, which transmits the collected data to an in-home modem.…”

Wearable Enzymatic Alcohol Biosensor

“…Despite these drawbacks, efforts to introduce the SCRAM offender-monitoring bracelet into alcohol addiction treatment were encouraging, with a large majority (81%) of wearers reporting the bracelet to be useful in helping them reduce drinking, although social discomfort and physical irritation was observed, related to the physical shape and size of the bracelet. [22,23].…”