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Principal Investigator: Nathalie Hill-Kapturczak
Organization: WASHINGTON STATE UNIVERSITY
Fiscal Year: 2024
Award: $691,670
Funding agency: National Institute on Alcohol Abuse and Alcoholism
PROJECT SUMMARY/ABSTRACT
In 2020, 28.3 million Americans experienced an alcohol use disorder (AUD); yet only 25% of these people
received treatment. During the pandemic, 60% of patients with a substance use disorder reported receiving
telehealth-based care for their addiction. The pivot to telehealth provides an opportunity to overcome the barriers
to access and retention that affect in-person care (e.g., inconvenience, stigma). In contingency management
(CM), people receive tangible reinforcers in exchange for submitting biological samples to verify abstinence. CM
is ideal for telehealth delivery and initial studies of telehealth models demonstrated reductions in alcohol use. At
the same time, these models have limitations. They require wearing a transdermal monitor or submitting multiple
breath samples daily. As a result, these approaches are costly, burdensome, and stigmatizing which limits their
feasibility. In part due to limitations of these biomarkers, current CM models are brief, averaging about 12 weeks,
despite evidence suggesting that longer CM interventions result in better post-treatment outcomes. Therefore,
the overall objective of our program of research is to utilize phosphatidylethanol (PEth), a blood-based biomarker
that can detect alcohol use for up to 28 days to deliver a feasible telehealth-based 26-week CM intervention. In
a pilot trial, we developed a telehealth-based PEth CM intervention where participants used a medical device,
the TASSO-M20 to self-collect blood for PEth testing under the observation of research staff over Zoom. This
intervention used a two-phase approach where the frequency of PEth testing and reinforcement was decreased
from once a week, to as infrequently as every four weeks once participants achieved a PEth level consistent
with two to four weeks of abstinence (< 20 ng/mL). Seventy-one percent of CM participants achieved >4 weeks
of abstinence versus 21% of the treatment as usual (TAU) group, and 43% of CM participants achieved >24
weeks of abstinence compared to 0% of the TAU group (p < 0.05). Based on these promising results, we now
propose to test our telehealth PEth-based CM model in a sample of adults with AUD (n=200), recruited via online
platforms by randomizing individuals to six months of 1) an online cognitive behavioral therapy for AUD
(CBT4CBT) and telehealth PEth-based CM (CM condition) or 2) CBT4CBT and reinforcers for submitting blood
samples (no abstinence required) (control condition). We will assess group differences in PEth-defined
abstinence and regular excessive drinking (PEth ³ 200 ng/mL), and alcohol-related harms (e.g., smoking, drug
use). We will address important gaps in CM research by assessing outcomes during a 12-month follow-up, which
is much longer than most previous CM studies; using a conceptual model to identify predictors of post-treatment
abstinence. The primary barrier to the dissemination of our model is the cost of PEth testing and CM reinforcers.
We will conduct an economic analysis to place these costs in the context of downstream CM-associated cost-
offsets and improvements in personal and public health. If our model increases alcohol abstinence and is cost-
effective it could reach millions of Americans with AUD that cannot or do not seek in-person care.
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