- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03987581
Cost Effectiveness of Combined Contingency Management and Cognitive Behavioral Therapy for Alcohol Use Disorder
March 18, 2024 updated by: Duke University
Alcohol contributes to 88,000 deaths and costs an estimated $223 billion annually in the United States.
Alcohol use disorder (AUD) is highly prevalent in veterans.
The positive public health impact of reducing heavy drinking among veterans with AUD would prevent significant medical morbidity and mortality.
Contingency management (CM) is an intensive behavioral therapy that provides incentives to individuals for reducing substance use.
Monitoring alcohol abstinence usually requires daily monitoring.
Because of this difficulty, CM approaches for treatment of AUD are not currently available to people with AUD.
Our group has developed a mobile smart-phone application that allows patients to video themselves using an alcohol breath monitor and transmit the encrypted data to a secure server.
This innovation has made the use of CM for outpatient AUD treatment feasible.
The aim of the current study is to evaluate the effectiveness and cost effectiveness of CM as an add-on to cognitive behavioral therapy for AUD.
The trial will also explore the potential usefulness of a long-term abstinence incentive ontreatment utilization and alcohol outcomes.
Proposed is a trial in which 140 veterans with AUD will be randomized to receive either CM as an add-on to evidence-based CBT or CBT alone.
Veterans will also be randomized to one of two long-term incentive conditions (i.e., receipt of a monetary incentive for abstinence/low-risk drinking at 6- months vs. no incentive).
This project aims to advance AUD treatment by 1) testing the effectiveness of a mobile health approach that makes CM for AUD feasible, and 2) providing highly needed cost-effectiveness data on the use of behavioral incentives as an adjunct to CBT for the treatment of AUD.
These aims are designed to address two significant barriers to the implementation of CM for AUD.
Study Overview
Status
Active, not recruiting
Conditions
Study Type
Interventional
Enrollment (Actual)
140
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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North Carolina
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Durham, North Carolina, United States, 27706
- Duke University Medical Center
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- are an enrolled veteran at the DVAHCS for primary care,
- have current AUD (meeting past month DSM-5 criteria), and
- are willing to make a quit attempt and/or reduce alcohol use to low risk levels.
Exclusion Criteria:
- have fewer than 3 days of abstinence,
- have a history of clinically significant alcohol withdrawal, as indicated by a score of 10 or more on the Clinical Institute Withdrawal Assessment of Alcohol (CIWA), or
- are currently receiving professional behavioral treatment for AUD.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: CBT + mCM + incentive
Participants in this arm will receive 12 sessions of cognitive behavioral treatment, mobile contingency management for alcohol abstinence, and a monetary incentive for 30-day abstinence at the 6-month follow-up.
|
Twelve in-person counseling sessions designed to assist participants with becoming abstinent from alcohol use (or reduce use).
Other Names:
Abstinence (measured by breath alcohol) will be intermittently reinforced.
For each breath alcohol concentration reading that tests negative, a participant will earn a virtual scratch-off lottery ticket that contains 100 different values.
Other Names:
This incentive is $300 for self-reported and bioverified 30-day abstinence from heavy drinking at the follow-up scheduled for 6-months after the initial quit date
Other Names:
|
Experimental: CBT + mCM + no incentive
Participants in this arm will receive 12 sessions of cognitive behavioral treatment and mobile contingency management for alcohol abstinence.
They will not receive monetary incentive for 30-day abstinence at the 6-month follow-up.
|
Twelve in-person counseling sessions designed to assist participants with becoming abstinent from alcohol use (or reduce use).
Other Names:
Abstinence (measured by breath alcohol) will be intermittently reinforced.
For each breath alcohol concentration reading that tests negative, a participant will earn a virtual scratch-off lottery ticket that contains 100 different values.
Other Names:
|
Experimental: CBT alone + incentive
Participants in this arm will receive 12 sessions of cognitive behavioral treatment and a monetary incentive for 30-day abstinence at the 6-month follow-up.
They will not receive contingency management for alcohol abstinence during the treatment period.
|
Twelve in-person counseling sessions designed to assist participants with becoming abstinent from alcohol use (or reduce use).
Other Names:
This incentive is $300 for self-reported and bioverified 30-day abstinence from heavy drinking at the follow-up scheduled for 6-months after the initial quit date
Other Names:
|
Active Comparator: CBT alone + no incentive
Participants in this arm will receive 12 sessions of cognitive behavioral treatment.
They will not receive monetary incentive for 30-day abstinence at the 6-month follow-up.
They will not receive contingency management for alcohol abstinence during the treatment period.
|
Twelve in-person counseling sessions designed to assist participants with becoming abstinent from alcohol use (or reduce use).
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average number of heavy drinking days
Time Frame: 6-month post quit visit
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At the 6-month follow-up visit, participants will self-report the number of heavy drinking (> 5 drinks in day for men, > 4 drinks in a day for women) days they have had in the past thirty days.
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6-month post quit visit
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average number of heavy drinking days
Time Frame: 12-month post quit visit
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At the 12-month follow-up visit, participants will self-report the number of heavy drinking (> 5 drinks in day for men, > 4 drinks in a day for women) days in the past thirty days.
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12-month post quit visit
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Average number of binge drinking days
Time Frame: 6-month post quit visit
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Participants will self-report the number of binge drinking (heavy drinking within a 2-hour period) days in the past thirty days.
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6-month post quit visit
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Average number of binge drinking days
Time Frame: 12-month post quit visit
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Participants will self-report the number of binge drinking (heavy drinking within a 2-hour period) days in the past thirty days.
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12-month post quit visit
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Average number of drinking days
Time Frame: 6-month post quit visit
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Participants will self-report the number of drinking days in the past thirty days.
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6-month post quit visit
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Average number of drinking days
Time Frame: 12-month post quit visit
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Participants will self-report the number of drinking days in the past thirty days.
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12-month post quit visit
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Average number of drinks per drinking day
Time Frame: 6-month post quit visit
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Participants will self-report the number of drinks on drinking days in the past 30 days.
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6-month post quit visit
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Average number of drinks per drinking day
Time Frame: 12-month post quit visit
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Participants will self-report the number of drinks on drinking days in the past 30 days.
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12-month post quit visit
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Self-reported abstinence
Time Frame: 6-month post quit visit
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Participants will self-report whether or not consumed any alcohol in the past 30 days.
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6-month post quit visit
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Self-reported abstinence
Time Frame: 12-month post quit visit
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Participants will self-report whether or not consumed any alcohol in the past 30 days.
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12-month post quit visit
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Bioverification of low-risk drinking
Time Frame: Post-treatment, approximately 14 weeks
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Participants will provide a fingerstick blood sample.
Phosphatidylethanol (PEth) testing will provide any evidence of excessive alcohol use in previous 4 weeks.
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Post-treatment, approximately 14 weeks
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Bioverification of low-risk drinking
Time Frame: 6-month post quit visit
|
Participants will provide a fingerstick blood sample.
Phosphatidylethanol (PEth) testing will provide any evidence of excessive alcohol use in previous 4 weeks.
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6-month post quit visit
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Bioverification of low-risk drinking
Time Frame: 12-month post quit visit
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Participants will provide a fingerstick blood sample.
Phosphatidylethanol (PEth) testing will provide any evidence of excessive alcohol use in previous 4 weeks.
|
12-month post quit visit
|
Treatment utilization
Time Frame: 6-month post quit visit
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Participants will provide self-report on use of adjunct treatments (e.g., Alcoholics Anonymous, group counseling) for alcohol use during the period between post-treatment and follow-ups.
Where available, Department of Veterans Affairs administrative data will be used to determine enrollment or involvement in aftercare treatment.
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6-month post quit visit
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Treatment utilization
Time Frame: 12-month post quit visit
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Participants will provide self-report on use of adjunct treatments (e.g., Alcoholics Anonymous, group counseling) for alcohol use during the period between post-treatment and follow-ups.
Where available, Department of Veterans Affairs administrative data will be used to determine enrollment or involvement in aftercare treatment.
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12-month post quit visit
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Health care related quality of life
Time Frame: 12-month post quit visit
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Health care related quality of life will be measured by the EuroQol.
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12-month post quit visit
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CBT treatment engagement
Time Frame: Post-treatment, approximately 14 weeks
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The number of cognitive behavioral therapy treatment sessions completed by each participant will be measured to determine treatment engagement
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Post-treatment, approximately 14 weeks
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Incremental Cost-Effectiveness Ratio
Time Frame: 12-month post quit visit
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Measure of cost-effectiveness; costs as the numerator and effectiveness as measured by quality-adjusted life years (QALY) as the denominator
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12-month post quit visit
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
November 26, 2019
Primary Completion (Estimated)
April 15, 2024
Study Completion (Estimated)
October 15, 2024
Study Registration Dates
First Submitted
June 11, 2019
First Submitted That Met QC Criteria
June 12, 2019
First Posted (Actual)
June 17, 2019
Study Record Updates
Last Update Posted (Actual)
March 19, 2024
Last Update Submitted That Met QC Criteria
March 18, 2024
Last Verified
March 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRO00101744
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
IPD Plan Description
There is no plan to share individual participant data.
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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