Remote Alcohol Monitoring to Facilitate Incentive‐Based Treatment for Alcohol Use Disorder: A Randomized Trial

Abstract

Background The delivery of monetary incentives contingent on verified abstinence is an effective treatment for alcohol use disorder. However, technological barriers to accurate, frequent biochemical verification of alcohol abstinence have limited the dissemination of this technique. Methods In the present randomized parallel trial, we employed a breathalyzer that allows remote, user‐verified collection of a breath alcohol sample, text messaging, and reloadable debit cards for remote delivery of incentives to evaluate a contingency management treatment for alcohol use disorder that can be delivered with no in‐person contact. Treatment‐seeking participants with alcohol use disorder (n = 40) were recruited from the community and randomized to either a contingent or a noncontingent group (n = 20 each). The contingent group received nearly immediate monetary incentives each day they remotely provided negative breathalyzer samples. The noncontingent group received matched monetary payments each day they successfully provided samples independent of alcohol content. Groups were not masked as awareness of group contingencies was an essential intervention component. Results The primary outcome of the intent‐to‐treat analyses (analyzed n = 40) was percent days abstinent as measured by the remote breathalyzer samples. Abstinence rates in the contingent group were 85%, which was significantly higher than the 38% recorded in the noncontingent group, corresponding to an odds ratio of 9.4 (95% CI = 4.0 to 22.2). Breathalyzer collection adherence rates were over 95%, and participant ratings of acceptability were also high. Conclusions These results support the efficacy, acceptability, and feasibility of this remotely deliverable abstinence reinforcement incentive intervention for the initiation and near‐term maintenance of abstinence from alcohol in adults with alcohol use disorder. Due to low provider and participant burden, this procedure has the potential for broad dissemination.

Pilot Study of an Integrated Smartphone and Breathalyzer Contingency Management Intervention for Alcohol Use

“…These findings were consistent with previous research, that suggests CM increases alcohol abstinence and other studies with similar adherence to submitting breath samples (Alessi and Petry, 2013;Hämäläinen et al, 2018). Although uEtG and PEth have longer alcohol detection periods than BAC, when paired with mobile technology the monitoring of alcohol using breathalyzers allows for cost-effective, feasible assessment and delivery of CM in the individual's natural environment (Dallery et al, 2013;Koffarnus et al, 2018).…”

“…Previous research has examined the use of smartphone applications and breathalyzers designed to monitor and reduce alcohol use (You et al, 2017). Few studies have combined the use of smartphones and breathalyzers with CM (Alessi and Petry, 2013;Koffarnus et al, 2018). In this randomized study, non-treatment seeking adults participated in a four-week CM intervention for alcohol use.…”

Smartphone-based incentives for promoting adherence to antiretroviral therapy: A randomized controlled trial

“…This raises the priority of cost-benefit studies and underscores the need for commercialization of contingency management services in a manner that is consistent with the literature on effective contingency management intervention design. Mobile contingency management interventions for drug and alcohol use, smoking, diabetes care, and medication non-adherence are effective ( Dallery et al, 2007 , Kurti et al, 0000 , Raiff and Dallery, 2010 , Raiff et al, 2016 , Koffarnus et al, 2018 ). Given the high cost associated with care for these health problems, it seems reasonable that mobile contingency management interventions designed to address these problems may be cost-effective as well and thereby attractive to health care payers.…”

mMotiv8: A smartphone‐based contingency management intervention to promote smoking cessation

“…Koffarnus et al (2018) also used facial recognition software in a technology‐based CM intervention targeting abstinence from alcohol. The authors employed a new alcohol breathalyzer called the Soberlink ® (Soberlink Healthcare, LLC, Huntington Beach, CA), which includes cellular service and an integrated web camera.…”