CONTINGENCY MANAGEMENT

Co-Occurring Alcohol and Serious Mental Illness

Global Contingency Management 

Alcohol Use in Housing

Technological Solutions

Alcohol Use in Native Populations

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Individualizing Incentives to Maximize Recovery

 

Up to 46 percent of adults with serious mental illnesses, such as schizophrenia, bipolar and depressive disorders, experience an alcohol use disorder in their lifetime, contributing to high rates of homelessness, psychiatric hospitalizations, HIV infection, cigarette smoking, and drug use. These public health concerns call for health interventions that help people cut down or stop drinking alcohol.

 

In our previous studies we found that contingency management, an intervention in which small incentives are provided to people who demonstrate evidence of drug or alcohol dependence, is an effective intervention for adults with serious mental illnesses. However, in our last study we found that those who had more severe alcohol problems, as measured by a urine test, ethyl glucuronide, didn’t respond to the contingency management intervention. Therefore, the primary purpose of this project is to determine whether modifications to contingency management, including increasing the amount of rewards for abstinence or rewarding people for reducing their use, prior to requiring abstinence, are effective for people who are heavy drinkers and are also living with serious mental illnesses. In this project we will also investigate factors that predict positive outcomes and conduct a comprehensive economic evaluation.

WASHINGTON STATE UNIVERSITY TEAM:

 

Principal Investigator

Michael McDonell, Ph.D.

 

Co-Investigators

Sterling McPherson, Ph.D.

Naomi Chaytor, Ph.D.

John Roll, Ph.D.

Postdoctoral Researcher

Julianne Jett, Ph.D.
 

Seattle Research Coordinators

Morgan Kelly, M.S

Spokane Research Coordinators
Sara Parent, N.D.

Mohammad Keshtkar, BS

PARTNERS: 

 

University of Washington Team

Richard Ries, Ph.D. - Co-Investigator

 

Weill Cornell Medicine Team

Sean Murphy, Ph.D. - Co-Investigator

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Phosphatidylethanol-Based Contingency Management for Housing

Contingency management (CM) is a behavioral intervention where incentives are provided in exchange for a biomarker that indicates substance abstinence. CM is effective at initiating abstinence from substances; however, it is less clear if CM is a model that can be used to maintain long-term abstinence. Phosphatidylethanol (PEth) is a novel blood-based biomarker with a long detection window of 14-28 days and is collected via a minimally invasive finger stick. Therefore, PEth may be used to implement a CM intervention where the frequency of alcohol monitoring and delivery of incentives can be as little as once a month, allowing for a feasible long-term CM intervention targeting alcohol.

 

This pilot-trial seeks to understand if a PEth-based CM intervention targeting initiation and maintenance of alcohol abstinence in formerly homeless, currently housed individuals with alcohol use disorders is acceptable to participants, feasible for staff, and is associated with increased alcohol abstinence and housing tenure. Acceptability and feasibility will be assessed using a QUANT+qual mixed methods. This protocol seeks to utilize a novel alcohol biomarker to deliver a long-term strategy for supporting those in supported housing with diagnosable alcohol use disorders. This treatment development trial will simultaneously assess initial intervention effectiveness, as well as factors that will influence implementation and dissemination of the intervention in a housing setting.

WASHINGTON STATE UNIVERSITY TEAM:

 

Principal Investigator

Michael McDonell, Ph.D.
 

Co-Investigator

Sterling McPherson, Ph.D.

Postdoctoral Researcher

Julianne Jett, Ph.D.

Research Coordinator

Rachael Beck, BA

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PARTNERS:

 

University of Texas Health Science San Antonio

Martin Javors, Ph.D., Co-Investigator

Nathalie Hill-Kapturczak, Ph.D., Co-Investigator

Washington University

Leopoldo Cabassa, Ph.D., Consultant

Funded by the NIAAA

 
 

HONOR

Helping Our Native Ongoing Recovery

Many American Indian/Alaska Native (AI/AN) communities struggle with disproportionately high rates of alcohol use in comparison to the general population. Despite this disparity, little information exists on effective alcohol treatments for AI/AN communities. Contingency Management (CM) is a low-cost intervention that gives participants rewards to reinforce positive behaviors, such as alcohol abstinence. Previous research suggests that CM is adaptable to many populations, and therefore might provide a promising alcohol treatment option for AI/ANs.

For the last five years we have been partnering with American Indian and Alaska Native communities to determine if contingency management for alcohol use is effective in improving outcomes in adults who are suffering from alcohol use disorders. The aim of this study is to determine whether rewarding abstinence from drugs, alcohol, or drugs and alcohol is the best way to reduce alcohol and drug use in a rural American Indian community. We have been partnering with these communities to determine whether a culturally tailored version of contingency management (which offers people rewards for abstaining from alcohol) can reduce alcohol use and lead to other healthy outcomes.

COMPLETED

PREPARING PUBLICATIONS

WASHINGTON STATE UNIVERSITY TEAM:

 

Principal Investigator
Michael McDonell, Ph.D.

Dedra Buchwald, Ph.D.

Co-Investigators

Sterling McPherson, Ph.D.

John Roll, Ph.D.

Lead Scientific Assistant
Abram Lyons, MSW

 

UNIVERSITY OF WASHINGTON TEAM: 

 

Co-Investigators

Richard Ries, Ph.D.

Dennis Donovan, Ph.D.

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PARTNERS:

South Central Foundation - A Native-owned, non-profit health care organization serving Alaska Native and American Indian people living in Alaska. 

Urban Indian Health Care Clinic and Community Center in the Northwest 
 

Rural Reservation in the Northern Plains

Using Smartphone Based Bluetooth Breathalyzers to Deliver Contingency Management

Roughly 80% of individuals in the United States currently own a smartphone device and more than five billion smartphone applications were downloaded by consumers. The widespread availability of smartphones and applications have provided alternative methods to monitoring substance use and delivering cost-effective treatments that also expand reach.

 

We are working with colleagues to develop and test a smartphone based contingency management intervention for alcohol use that allows for the delivery of treatment outside of a clinic setting. The long-term goal is to provide this effective treatment to the 85% of people with alcohol problems who never receive treatment.

 

DIPT Drinkers Intervention to Prevent Tuberculosis

Globally, approximately 25% of persons with HIV are heavy drinkers, and heavy alcohol use is associated with a 3-fold higher risk of TB disease compared to no alcohol use. Thus, HIV-infected persons who drink alcohol are at high risk for TB. As a Co-Investigator, Dr. McDonell provides his expertise as the investigative team and research staff in Uganda use an incentive- based intervention to reduce alcohol use and increase medication safety in Uganda using ethyl glucuronide (EtG) dipsticks to test for alcohol use. The aim of this study is to provide new information on low-cost strategies to reduce alcohol use and increase isoniazid preventative therapy adherence in low-income countries.

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PARTNERS

 

University of California, San Francisco

Judith Hahn, Ph.D., Principal Investigator

 

University of California, San Francisco

Gabriel Chamie, MD, Principal Investigator

Infectious Disease Research Collaboration (IDRC)

Dalsone Kwarisiima, MBChB, MPH

Mbarara Regional Referral Hospital, Mbarara Uganda

Winnie Muyindike, MBChB, MMED

Mbarara, Uganda Contact

WASHINGTON STATE UNIVERSITY TEAM:

 

Investigator
Michael McDonell, Ph.D.

 

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