Wednesday, March 3, 2021

Rewards for Behavioral Change May Be Effective for Alcohol Use Disorder in Native Populations

Contingency management, in which patients are rewarded for behavioral change, may be an effective strategy for increasing alcohol abstinence in American Indian and Alaska Native adults, a study in JAMA Psychiatry has found.

Michael G. McDonnell, Ph.D., of the Elson S. Floyd College of Medicine at Washington State University, Spokane, and colleagues analyzed data from 158 American Indian and Alaska Native adults who had at least one or more days of high alcohol use (more than three drinks) within the last 30 days and a current diagnosis of alcohol dependence. All patients in the study submitted urine samples twice per week for 12 weeks after a four-week observation period and completed follow-up interviews at one, two, and three months afterward. All patients received treatment as usual, which included culturally adapted individual and group addiction counseling on an outpatient basis, or referral for intensive outpatient addiction treatment that was not culturally adapted. Cultural adaptations included receiving care from tribal members and receiving materials in the patients’ native languages.

Patients were divided into two groups: the contingency management group and the control group. Those in the contingency management group received incentives through prize drawings when their urine samples indicated alcohol abstinence. Those in the control group drew for prizes each time they submitted a urine sample regardless of whether the sample indicated abstinence from alcohol. Prizes included positive affirmations; $1, $20, and $80 cash rewards; gift cards; and more.

At 16 weeks, 59.4% of patients in the contingency management group submitted an alcohol-negative urine sample, compared with 38.3% in the control group. Those in the contingency management group had a 1.70-fold higher likelihood of submitting alcohol-abstinent urine samples than those in the control group.

“Our findings demonstrate that contingency management is a low-cost, feasible, and culturally adaptable incentive program that leads to modest improvements in alcohol abstinence during a 12-week intervention period,” McDonnell and colleagues wrote. “Policymakers and health care professionals may consider investing in contingency management as a strategy for improving the treatment of alcohol use disorder among American Indian and Alaska Native adults.”

For related information, see the American Journal of Psychiatry article “A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.”

(Image: iStock/Zinkevych)

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