Virtual Incentive Treatment for Alcohol (VITA)
Assessing the Clinical and Cost-Effectiveness of a Virtual PEth-based Contingency Management for Adults With AUD
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Rachael M Beck, BS
- Phone Number: 509-818-7024
- Email: prism.vitastudy@wsu.edu
Study Contact Backup
- Name: Julianne Jett, PhD
- Phone Number: 509-368-6816
- Email: julianne.jett@wsu.edu
Study Locations
-
-
Washington
-
Spokane, Washington, United States, 99201
- Recruiting
- Washington State University
-
Contact:
- Michael McDonell, PhD
- Phone Number: 509-368-6967
- Email: mmcdonell@wsu.edu
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Had 2 heavy drinking episodes (assigned male at birth > 4 standard drinks (SDs), assigned female at birth > 3 SDs) or ≥14 SDs in the prior 14 days verified by PEth 16:0/18:1 biomarker > 20 ng/mL (indicates at least 2 heavy drinking episodes in past two weeks);
- Have a DSM-5 diagnosis of a current AUD as assessed by the Structured Clinical Interview for DSM-5;
- 18+ (individuals over 65 will be assessed for cognitive impairments)
- Are not receiving treatment for AUD
- Are able to complete virtual study visits via Zoom
Exclusion Criteria:
- have a current diagnosis of severe substance use disorder (other than AUD, tobacco, and cannabis);
- PEth biomarker ≤ 20 ng/mL (indicates no heavy drinking in past month)
- inability to provide informed consent based on the UBACC or MacCAT-CR;
- alcohol withdrawal-related seizure or hospitalization in prior 12 months;
- psychiatrically or medically unsafe to participate, as assessed by the PI; and/or
- currently enrolled in alcohol treatment or another alcohol treatment study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Control Condition (Non-contingent Incentives + CBT4CBT)
Participants will receive 8 weeks of Computer Based Training for Cognitive Behavioral Health (CBT4CBT).
CBT4BCT is a self paced web-based program that uses videos and lessons to help people learn skills they can use to cut down or stop drinking.
Participants will receive a $10 e-gift card for every PEth sample submitted within 48 hours of the visit regardless of the result.
Participants will receive gift card incentives when they attend visits and provide blood samples (PEth Samples).
Participants will submit PEth samples weekly for the first four weeks of the study, then every two weeks (weeks six, eight), then every four weeks (weeks 12,16, 20, 24), and at week 26.
Each time they submit a PEth sample, they will receive gift cards equal to the average CM earnings during the previous month, resulting in total average earnings equivalent to the CM group.
This group will receive incentives regardless of the results of their PEth tests.
|
CBT4CBT is an evidence-based online intervention that teaches CBT principles and skills to help people with alcohol use disorder reduce their drinking.
CBT4CBT teaches CBT principles through video, graphics, audio instruction, and interactive exercises.
Modules include video-based examples to emphasize learning of behavioral, cognitive, and affective strategies, with an emphasis on learning from examples of individuals using skills in a range of situations.
Skills taught include functional analysis, coping with craving and emotions, problem solving, decision making, challenging thoughts, and assertive alcohol refusal.
Interactive exercises and homework are used to encourage skills learning and practice.
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|
Experimental: CM Condition (Contingency Management + CBT4CBT)
Participants will receive 8 weeks of CBT4CBT and incentives for timely shipping.
In addition, those in the CM Condition will receive at least $20 for each PEth-negative sample.
Participants will receive an additional $5 for each week of consecutive negative PEth tests, with a $90 cap.
In Initiation Phase, participants will attend virtual visits, provide PEth samples, and be rewarded for a decrease in PEth weekly.
Maintenance Phase will begin when a participant's PEth sample is < 20 ng/mL.
In Maintenance Phase, participants will attend visits and submit PEth samples every two weeks for four weeks (i.e., weeks 6 & 8).
They will then attend visits and submit PEth samples every four weeks (weeks 12, 16, 20, 24), and on week 26.
If participants submit a positive PEth sample, they will return to Initiation Phase and receive $20 for their next negative sample.
Participants will attend visits and submit samples weekly until their PEth level is < 20 ng/mL and they restart Maintenance Phase.
|
CBT4CBT is an evidence-based online intervention that teaches CBT principles and skills to help people with alcohol use disorder reduce their drinking.
CBT4CBT teaches CBT principles through video, graphics, audio instruction, and interactive exercises.
Modules include video-based examples to emphasize learning of behavioral, cognitive, and affective strategies, with an emphasis on learning from examples of individuals using skills in a range of situations.
Skills taught include functional analysis, coping with craving and emotions, problem solving, decision making, challenging thoughts, and assertive alcohol refusal.
Interactive exercises and homework are used to encourage skills learning and practice.
Contingency Management (CM) is an intervention that uses positive reinforcement (e.g.
gift cards) to reinforce a desired behavior (e.g.
negative alcohol biomarker tests) on a frequent (e.g.
weekly), escalating (e.g.
$5/week) schedule (e.g. 26 weeks) in order to increase the occurrence of that behavior (e.g.
long term alcohol abstinence or reduction in drinking).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Aim 1) Alcohol Abstinence & Aim 3) Predictors: PEth-Defined Alcohol Abstinence During CM (Aim 1) and Follow-Up (Aim 3)
Time Frame: Every study visit, up to 18 months
|
Investigators will use PEth 16:0/18:1, detectable from 8 to 5,000+ ng/mL via HPLC/MS/MS to assess the primary outcome.
Abstinence from alcohol, the primary outcome, will be defined as a week-over-week PEth 16:0/18:1 reduction in Initiation Phase and PEth 16:0/18:1 < 20 ng/mL in Maintenance Phase.
The primary Aim 3 outcome will be PEth-defined abstinence (PEth 16:0/18:1 < 20 ng/mL) during the 12-month follow-up.
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Every study visit, up to 18 months
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Aim 2) Alcohol-Related Harms: Addiction Severity Index (ASI) Lite
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
The ASI Lite will be used to assess the impact of alcohol use on psychiatric, legal, medical, and family functioning, as well as self-reported drug use.
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Once a month during the intervention, Follow Up, up to 18 months
|
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Aim 2) Alcohol-Related Harms: Patient Health Questionnaire-9 (PHQ-9)
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
Depression symptoms will be assessed with the PHQ-9.
Scores range from 0-27.
A score of 1-4 is consistent with minimal depression, a score of 5-9 is consistent with mild depression, a score of 10-14 is consistent with moderate depression, a score of 15 to 19 is consistent with moderately severe depression, and a score of 20-27 is consistent with severe depression.
Lower depression scores are treated as a better outcome.
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Once a month during the intervention, Follow Up, up to 18 months
|
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Aim 2) Alcohol-Related Harms: Generalized Anxiety Disorder-7 (GAD-7)
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
Anxiety symptoms will be assessed using the GAD-7.
A score of 0-4 is consistent with minimal anxiety, 5-9 with mild anxiety, 10-14 with moderate anxiety, and 15-21 with severe anxiety.
A lower anxiety score is treated as a better outcome.
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Once a month during the intervention, Follow Up, up to 18 months
|
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Aim 2) Alcohol-Related Harms: Short Form Health Survey-12 (SF-12)
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
Physical health will be assessed using the SF-12.
Scores above 50 indicate a better-than-average health-related quality of life, while scores below 50 suggest below-average health.
Higher scores will be considered a more positive outcome.
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Once a month during the intervention, Follow Up, up to 18 months
|
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Aim 2) Alcohol-Related Harms & Aim 4) Cost Analysis: Non-study Medical and Other Services (NMOS) form
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
Service utilization, employment, and education will be assessed by self-report using an NMOS form.
Healthcare utilization will be assessed by self-reported, time-anchoring methods.
Healthcare services will include non-study: inpatient, outpatient, emergency department; SUD medications; residential and outpatient SUD treatment days; hospital detoxification days; and mental health treatment visits.
This information will be gathered for the 30 days prior to baseline, then "since the last assessment."
Use of non-medical and other resources required for the economic evaluation from state-policymaker and societal perspectives (e.g., criminal-legal, safety-net utilization, labor productivity, travel time to medical care) will also be collected.
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Once a month during the intervention, Follow Up, up to 18 months
|
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Aim 2) Alcohol Related Harms: Fagerstrom
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
Nicotine use will be assessed using the Fagerstrom Test for Nicotine Dependence.
|
Once a month during the intervention, Follow Up, up to 18 months
|
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Aim 2) Alcohol Related Harms: Urine Drug Tests
Time Frame: Every study visit, up to 18 months
|
Point of care urine drug test immunoassay cups will be used to assess cocaine, amphetamine, methamphetamine, cannabis, and opioid use .
Participants will collect urine in the privacy of their bathroom, and display the results of their urine drug test on camera to study staff.
Results are binary positive/negative for each drug class.
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Every study visit, up to 18 months
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Aim 2) Alcohol Related Harms: Perceived Stress Scale (PSS-10)
Time Frame: Every study visit, up to 18 months
|
Stress will be assessed with the 10-item PSS-10 to determine perceived stress.
Scores ranging from 0-13 would be considered low stress.
Scores ranging from 14-26 would be considered moderate stress.
Scores ranging from 27-40 would be considered high perceived stress.
Lower scores will be considered better outcomes.
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Every study visit, up to 18 months
|
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Aim 3) Predictors: Demographics
Time Frame: Baseline
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Demographics, such as age, sex assigned at birth, gender, race, ethnicity, education level, housing status, and income will be assessed of predictors of alcohol use outcomes.
|
Baseline
|
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Aim 3) Predictors: Addictions Neuroclinical Assessment (ANA) Questionnaire
Time Frame: Every study visit, up to 18 months
|
The ANA domains of executive functioning, negative affect, and incentive salience will be assessed via a 15-item questionnaire.
Subdomains will be assessed as predictors of alcohol use outcomes.
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Every study visit, up to 18 months
|
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Aim 3) Predictors: TestMyBrain
Time Frame: Baseline
|
Performance-base measures of executive functioning, including divided attention, working memory, mental flexibility, response inhibition, impulsivity, and delay discounting will be self-administered remotely using the TestMyBrain.org
platform
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Baseline
|
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Aim 3) Predictors: Positive Negative Affect Schedule (PANAS)
Time Frame: Every study visit, up to 18 months
|
Anhedonia will be measured with the 20-item PANAS.
Positive Affect Score: Scores can range from 10 - 50, with higher scores representing higher levels of positive affect.
Negative Affect Score: Scores can range from 10 - 50, with lower scores representing lower levels of negative affect.
Scores will be assessed as predictors of alcohol use outcomes.
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Every study visit, up to 18 months
|
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Aim 3) Predictors: Situational Confidence Questionnaire-8 (SCQ-8)
Time Frame: Every study visit, up to 18 months
|
Alcohol Craving will be measured with the 8-item SCQ-8.
Each item, representing a "situation", is scored from 0 to 100.
High scores (80 and above) indicate high confidence in being able to cope with craving.
Low scores (0 to 20) indicate lower confidence in coping with craving and avoiding alcohol use.
A global self-efficacy score can be calculated by taking the average of all of the situations.
Scores will be assessed as predictors of alcohol use outcomes.
|
Every study visit, up to 18 months
|
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Aim 3) Predictors: Alcohol Craving VAS
Time Frame: Every study visit, up to 18 months
|
Alcohol Craving self-report over the past week and during the visit will be measured with a 1-100 Visual Analog Scale.
A score of 0 is consistent with no alcohol craving, a score of 100 is consistent with the most alcohol craving.
Scores will be assessed as predictors of alcohol use outcomes.
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Every study visit, up to 18 months
|
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Aim 4) Cost Analysis: Drug Abuse Treatment Cost Analysis Program (DATCAP)
Time Frame: Baseline
|
Resources required to implement and sustain each intervention will be identified via microcosting analysis and the DATCAP, a standardized, customizable tool that captures intervention costs in a manner conducive to estimating costs across settings.
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Baseline
|
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Aim 4) Cost Analysis: PROPr
Time Frame: Once a month during the intervention, Follow Up, up to 18 months
|
The Patient-Reported Outcomes Measurement Information System (PROMIS)-Preference (PROPr) measures a participant's health-related quality-of-life (HRQoL) across PROMIS domains of cognition, depression, anxiety, fatigue, pain interference, pain intensity, physical function, sleep disturbance, and ability to participate in social roles and activities.
PROPr can generate a health utility index value, based on the participant's domain scores, that represents the US population's reference for the respondent's current health state.
PROPr has five levels for each domain, ranging from "no" to "extreme" problems.
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Once a month during the intervention, Follow Up, up to 18 months
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Aim 1) Alcohol Abstinence: Regular excessive drinking
Time Frame: Every study visit, up to 18 months
|
Defined as PEth 16:0/18:1 >=200 ng/mL.
|
Every study visit, up to 18 months
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Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Aim 1) Alcohol Abstinence: uEtG-Defined Alcohol Abstinence
Time Frame: Every study visit, up to 18 months
|
Urine samples will be tested for uEtG at each visit using uEtG dipcards with a threshold of 300 ng/mL
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Every study visit, up to 18 months
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Aim 1) Alcohol Abstinence: Self-reported Alcohol Abstinence and Heavy Drinking
Time Frame: Every study visit, up to 18 months
|
Assessed by the Alcohol Timeline Follow Back (TLFB)
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Every study visit, up to 18 months
|
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Additional Implementation Data: Attrition
Time Frame: Every study visit, up to 18 months
|
We will record attrition, defined as one month of no contact with the study team, and track attendance at study appointments.
|
Every study visit, up to 18 months
|
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Additional Implementation Data: CSQ-8
Time Frame: Weeks 4 & 26
|
To assess participant satisfaction, we will administer the 8-item Client Satisfaction Questionnaire (CSQ-8) at weeks four and 26, with a mean score of > 23 indicating overall satisfaction.
|
Weeks 4 & 26
|
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Adverse Events
Time Frame: Every study visit, up to 18 months
|
Risks related to suicidality, dangerous alcohol use, and withdrawal symptoms will be recorded.
Withdrawal symptoms will be assessed at every visit using the Sweating, Hallucinations, Orientation, Tremor (SHOT) scale, with adaptations for virtual observation and evaluation.
Time spent in inpatient mental and physical health care, incarceration, visits to residential treatment programs, and other controlled environments will be recorded.
Symptoms of suicidal risk will be assessed at monthly and follow-up visits.
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Every study visit, up to 18 months
|
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Computer Based Training for Cognitive Behavioral Health (CBT4CBT) Program Use
Time Frame: Treatment & Follow up, up to 18 months
|
Completion of CBT4CBT modules, scores on practice quizzes, and participant reported use of CBT4CBT skills will be recorded.
|
Treatment & Follow up, up to 18 months
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Michael McDonell, PhD, Washington State University Elson S. Floyd College of Medicine
- Principal Investigator: Nathalie Hill-Kapturczak, PhD, University of Texas Health San Antonio
- Principal Investigator: Sean Murphy, PhD, Weill Cornell
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
- Longitudinal Studies
- Telehealth
- Adult
- Cognition
- Blood
- Contingency Management
- Anhedonia
- Cognitive Therapy
- Biological Markers
- Randomized Clinical Trial
- Heavy Drinking
- Incentives
- Clinical effectiveness
- Phosphatidylethanol
- Virtual Health
- Health Care Costs
- Blood collection
- Video conference
- Alcohol Abstinence
- Ethyl glucuronide
- Addictions Neuroclinical Assessment
- Incentive salience
- Prediction of Response to Therapy
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 20320
- R01AA031013 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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