Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness

Contemp Clin Trials. 2018 Jun:69:92-98. doi: 10.1016/j.cct.2018.04.010. Epub 2018 Apr 20.


Background: In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG >349ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders.

Aims: To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative to those who receive typical low-magnitude abstinence based CM (Usual CM). Additionally, variables in the Addictions Neuroclinical Assessment model will be examined as treatment response moderators.

Methods: Participants (N=400) will be recruited from two urban mental health organizations and complete a 4-week induction period where they will be reinforced for submitting samples for uEtG testing. Participants who attain a mean uEtG >349mg/mL will be randomized to receive either Usual CM, High-Magnitude CM, or Shaping CM for 16weeks. Differences in abstinence, assessed by uEtG, will be examined during treatment and during a 12-month follow-up. Measures of negative emotionality, alcohol reinforcer salience, and executive functioning will be gathered at study intake and used to predict treatment outcomes.

Discussion: This novel approach to CM will use an alcohol biomarker to identify those at risk for treatment non-response and determine if adaptations to CM might improve outcomes for this group.

Keywords: Alcohol treatment; Contingency management; Ethyl glucuronide; Serious mental illness addictions neuroclinical assessment.

Publication types

  • Clinical Trial Protocol
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alcohol Abstinence / psychology*
  • Alcohol Drinking* / psychology
  • Alcohol Drinking* / therapy
  • Behavior Therapy / methods*
  • Female
  • Humans
  • Male
  • Mental Disorders* / psychology
  • Mental Disorders* / therapy
  • Middle Aged
  • Patient Care Management / methods
  • Reinforcement, Psychology*
  • Reward*
  • Treatment Outcome