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Clinical Trial
. 2015 Apr;39(4):743-51.
doi: 10.1111/acer.12687.

Using Contingency Management Procedures to Reduce At-Risk Drinking in Heavy Drinkers

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Free PMC article
Clinical Trial

Using Contingency Management Procedures to Reduce At-Risk Drinking in Heavy Drinkers

Donald M Dougherty et al. Alcohol Clin Exp Res. .
Free PMC article

Abstract

Background: Treatments for alcohol use disorders typically have been abstinence based, but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences, have gained in popularity. This study used a contingency management procedure to determine its effectiveness in reducing alcohol consumption among heavy drinkers.

Methods: Eighty-two nontreatment-seeking heavy drinkers (ages 21 to 54, M = 30.20) who did not meet diagnostic criteria for alcohol dependence participated in the study. The study had 3 phases: (i) an Observation phase (4 weeks) where participants drank normally; (ii) a Contingency Management phase (12 weeks) where participants were paid $50 weekly for not exceeding low levels of alcohol consumption as measured by transdermal alcohol concentrations, <0.03 g/dl; and (iii) a Follow-up phase (12 weeks) where participants (n = 66) returned monthly for 3 months to self-report drinking after the contingencies were removed. Transdermal alcohol monitors were used to verify meeting contingency requirements; all other analyses were conducted on self-reported alcohol use.

Results: On average 42.3% of participants met the contingency criteria and were paid an average of $222 during the Contingency Management phase, with an average $1,998 in total compensation throughout the study. Compared to the Observation phase, the percent of any self-reported drinking days significantly decreased from 59.9 to 40.0% in the Contingency Management and 32.0% in the Follow-up phases. The percent of self-reported heavy drinking days reported also significantly decreased from 42.4% in the Observation phase to 19.7% in the Contingency Management phase, which was accompanied by a significant increase in percent days of self-reported no (from 40.1 to 60.0%) and low-level drinking (from 9.9 to 15.4%). Self-reported reductions in drinking either persisted, or became more pronounced, during the Follow-up phase.

Conclusions: Contingency management was associated with a reduction in self-reported episodes of heavy drinking among nontreatment-seeking heavy drinkers. These effects persisted even after incentives were removed, indicating the potential utility of contingency management as a therapeutic intervention to reduce harmful patterns of drinking.

Keywords: Contingency Management; Excessive Alcohol Use; Harm Reduction; Self-Report; Transdermal Monitors.

Figures

Figure 1
Figure 1
Flow chart of participant enrollment and retention throughout the three phases.
Figure 2
Figure 2
Percent of participants who met contingency criteria (TAC < 0.03 g/dl) each week during the Observation and Contingency Management phases. The percent of participants meeting contingency criteria was higher in the Contingency Management phase compared to the Observation phase (** p < 0.01).
Figure 3
Figure 3
Average percent of days per week of No Drinking (white circles), Low Drinking (light grey triangles), Moderate Drinking (dark grey diamonds), and Heavy Drinking (black squares) for all participants. Drinking levels (collected by Timeline-Follow-Back methods) included: No drinking (units = 0); low drinking (units > 0 but < 3); moderate drinking (units ≥3 but <4 for women; ≥3 but <5 for men); high drinking (units ≥ 4 for women; ≥5 for men). All drinking levels during the Contingency Management and Follow-up phases differed significantly from drinking levels in the Observation phase (all p < 0.001).

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