Remotely administered incentive-based treatment for alcohol use disorder with participant-funded incentives is effective but less accessible to low-income participants

Abstract

The delivery of monetary incentives contingent on verified abstinence is an effective treatment for alcohol use disorder. However, incentive cost has often been cited as a barrier to delivering this type of treatment. In the present randomized parallel groups trial, we systematically replicated a previous trial we conducted that employed remote alcohol monitoring and incentive delivery to promote abstinence from alcohol, but with the additional requirement for participants to partially self-fund their abstinence incentives. Treatment-seeking participants with alcohol use disorder (n = 92) who met inclusion criteria (n = 36) were randomized to either a Contingent or Noncontingent group (n = 18 each). Those not meeting inclusion criteria included 15 participants who agreed to the deposit requirement but failed to make the deposit payment. The Contingent group received nearly immediate monetary incentives each day they remotely provided negative breathalyzer samples. The Noncontingent group received matched incentives each day they successfully provided samples independent of alcohol content. Days abstinent in the Contingent group were 86%, which was significantly higher than the 44% recorded in the Noncontingent group, corresponding to an odds ratio of 8.2. Exploratory analyses revealed that the deposit requirement prevented participation in those with lower incomes and those with greater alcohol use. These results support the efficacy of this remotely deliverable alcohol abstinence reinforcement incentive intervention with a deposit requirement. However, the requirement to provide a monetary deposit to self-fund abstinence incentives may prevent those with greater alcohol use and/or those experiencing extreme poverty from participating in the intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT04182022.

Figures

Figure 1:

CONSORT Diagram Depicting Participant Inclusion and Exclusion

Figure 2:

Remote Breathalyzer Results Note. Abstinence and individual sample collection rate results from the thrice-daily remote breathalyzer assessments during the Treatment phase. Percent days abstinent was significantly higher in the Contingent group (top), and the collection rate was similarly high in both groups (bottom).

Figure 3:

Daily Participant Self-Reports Note. Daily self-reports of drinks per day and withdrawal symptoms collected throughout the Monitoring Only and Treatment phases. Drinks per day were significantly lower in the Contingent group during the Treatment phase only (top), and withdrawal symptoms were similarly low throughout the study in both groups (bottom).

Figure 4:

Alcohol Use Quantity and Problems Note. Indicators of alcohol use quantity as measured by the Timeline Follow-back assessment (top) and problems associated with alcohol use as measured by the AUDIT assessment (bottom). Numeric labels near points indicate the number of participants to complete an assessment and asterisks indicate a significant treatment effect between groups (p < .05).

Figure 5:

Participant Ratings of Treatment Acceptability