A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness
Objective:The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management w...
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| Veröffentlicht in: | The American journal of psychiatry 2017-04, Vol.174 (4), p.370-377 |
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| container_title | The American journal of psychiatry |
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| creator | McDonell, Michael G Leickly, Emily McPherson, Sterling Skalisky, Jordan Srebnik, Debra Angelo, Frank Vilardaga, Roger Nepom, Jenny R Roll, John M Ries, Richard K |
| description | Objective:The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior.Method:Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples ( |
| doi_str_mv | 10.1176/appi.ajp.2016.16050627 |
| format | Article |
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Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior.Method:Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods.Results:Contingency management participants were 3.1 times (95% CI=2.2–4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up.Conclusions:This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.</description><identifier>ISSN: 0002-953X</identifier><identifier>EISSN: 1535-7228</identifier><identifier>DOI: 10.1176/appi.ajp.2016.16050627</identifier><identifier>PMID: 28135843</identifier><identifier>CODEN: AJPSAO</identifier><language>eng</language><publisher>United States: American Psychiatric Association</publisher><subject>Adult ; Alcohol use ; Alcoholism - epidemiology ; Alcoholism - psychology ; Alcoholism - therapy ; Alcoholism - urine ; Ambulatory Care ; Comorbidity ; Comparative analysis ; Diagnosis, Dual (Psychiatry) ; Female ; Follow-Up Studies ; Glucuronates - urine ; Humans ; Intervention ; Male ; Mental disorders ; Mental Disorders - blood ; Mental Disorders - epidemiology ; Mental Disorders - psychology ; Mental Disorders - therapy ; Mental health care ; Middle Aged ; Patient Compliance - psychology ; Token Economy</subject><ispartof>The American journal of psychiatry, 2017-04, Vol.174 (4), p.370-377</ispartof><rights>Copyright © 2017 by the American Psychiatric Association 2017</rights><rights>Copyright American Psychiatric Publishing, Inc. Apr 1, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a486t-e181d360b984239b25c3cdc6f8a024965f77347c6230c0703e3796f99b2df15c3</citedby><cites>FETCH-LOGICAL-a486t-e181d360b984239b25c3cdc6f8a024965f77347c6230c0703e3796f99b2df15c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://psychiatryonline.org/doi/epdf/10.1176/appi.ajp.2016.16050627$$EPDF$$P50$$Gappi$$H</linktopdf><linktohtml>$$Uhttps://psychiatryonline.org/doi/full/10.1176/appi.ajp.2016.16050627$$EHTML$$P50$$Gappi$$H</linktohtml><link.rule.ids>230,314,776,780,881,2842,21605,21606,21607,27901,27902,77537,77542</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28135843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McDonell, Michael G</creatorcontrib><creatorcontrib>Leickly, Emily</creatorcontrib><creatorcontrib>McPherson, Sterling</creatorcontrib><creatorcontrib>Skalisky, Jordan</creatorcontrib><creatorcontrib>Srebnik, Debra</creatorcontrib><creatorcontrib>Angelo, Frank</creatorcontrib><creatorcontrib>Vilardaga, Roger</creatorcontrib><creatorcontrib>Nepom, Jenny R</creatorcontrib><creatorcontrib>Roll, John M</creatorcontrib><creatorcontrib>Ries, Richard K</creatorcontrib><title>A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness</title><title>The American journal of psychiatry</title><addtitle>Am J Psychiatry</addtitle><description>Objective:The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior.Method:Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods.Results:Contingency management participants were 3.1 times (95% CI=2.2–4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up.Conclusions:This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.</description><subject>Adult</subject><subject>Alcohol use</subject><subject>Alcoholism - epidemiology</subject><subject>Alcoholism - psychology</subject><subject>Alcoholism - therapy</subject><subject>Alcoholism - urine</subject><subject>Ambulatory Care</subject><subject>Comorbidity</subject><subject>Comparative analysis</subject><subject>Diagnosis, Dual (Psychiatry)</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glucuronates - urine</subject><subject>Humans</subject><subject>Intervention</subject><subject>Male</subject><subject>Mental disorders</subject><subject>Mental Disorders - blood</subject><subject>Mental Disorders - epidemiology</subject><subject>Mental Disorders - psychology</subject><subject>Mental Disorders - therapy</subject><subject>Mental health care</subject><subject>Middle Aged</subject><subject>Patient Compliance - psychology</subject><subject>Token Economy</subject><issn>0002-953X</issn><issn>1535-7228</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks1uEzEUhS0EomnhFSpLbNhM8M-Mx7NBCqEtlVpFglawsxyPJ3Hk2IM9gxQehyflhqTlZ8HKvvJ3zr1XPgidUzKltBZvdN-7qd70U0aomFJBKiJY_QRNaMWromZMPkUTQggrmop_OUGnOW-gJLxmz9EJk5RXsuQT9GOGP-rQxq37bls8j2FI0Xu43iWnPY4dvhjWO4-v_GjGFINrbfFO5yPrwsoGs8O3OuiV3dow4C4mvBiHXg8Oyow_u2ENbLEwoE8gwDNv4jp6fJ8tfu9yTK1NGcMQ-JNNLo4Z34ISml97H2zOL9CzTvtsXx7PM3R_eXE3_1DcLK6u57ObQpdSDIWlkrZckGUjS8abJasMN60RndSElY2ourrmZW0E48SQmnDL60Z0DZBtRwE-Q28Pvv243NrWwBBJe9Unt9Vpp6J26u-X4NZqFb-pitdSVBQMXh8NUvw62jyorcvGeq-DhbUUlYIzRqRsAH31D7qJYwqwHlANo41kFQNKHCiTYs7Jdo_DUKL2MVD7GCiIgdrHQD3EAITnf67yKHv4dwD4Afhl8Lv3_21_Ao5Pwzw</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>McDonell, Michael G</creator><creator>Leickly, Emily</creator><creator>McPherson, Sterling</creator><creator>Skalisky, Jordan</creator><creator>Srebnik, Debra</creator><creator>Angelo, Frank</creator><creator>Vilardaga, Roger</creator><creator>Nepom, Jenny R</creator><creator>Roll, John M</creator><creator>Ries, Richard K</creator><general>American Psychiatric Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170401</creationdate><title>A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness</title><author>McDonell, Michael G ; Leickly, Emily ; McPherson, Sterling ; Skalisky, Jordan ; Srebnik, Debra ; Angelo, Frank ; Vilardaga, Roger ; Nepom, Jenny R ; Roll, John M ; Ries, Richard K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a486t-e181d360b984239b25c3cdc6f8a024965f77347c6230c0703e3796f99b2df15c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Alcohol use</topic><topic>Alcoholism - epidemiology</topic><topic>Alcoholism - psychology</topic><topic>Alcoholism - therapy</topic><topic>Alcoholism - urine</topic><topic>Ambulatory Care</topic><topic>Comorbidity</topic><topic>Comparative analysis</topic><topic>Diagnosis, Dual (Psychiatry)</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glucuronates - urine</topic><topic>Humans</topic><topic>Intervention</topic><topic>Male</topic><topic>Mental disorders</topic><topic>Mental Disorders - blood</topic><topic>Mental Disorders - epidemiology</topic><topic>Mental Disorders - psychology</topic><topic>Mental Disorders - therapy</topic><topic>Mental health care</topic><topic>Middle Aged</topic><topic>Patient Compliance - psychology</topic><topic>Token Economy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McDonell, Michael G</creatorcontrib><creatorcontrib>Leickly, Emily</creatorcontrib><creatorcontrib>McPherson, Sterling</creatorcontrib><creatorcontrib>Skalisky, Jordan</creatorcontrib><creatorcontrib>Srebnik, Debra</creatorcontrib><creatorcontrib>Angelo, Frank</creatorcontrib><creatorcontrib>Vilardaga, Roger</creatorcontrib><creatorcontrib>Nepom, Jenny R</creatorcontrib><creatorcontrib>Roll, John M</creatorcontrib><creatorcontrib>Ries, Richard K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McDonell, Michael G</au><au>Leickly, Emily</au><au>McPherson, Sterling</au><au>Skalisky, Jordan</au><au>Srebnik, Debra</au><au>Angelo, Frank</au><au>Vilardaga, Roger</au><au>Nepom, Jenny R</au><au>Roll, John M</au><au>Ries, Richard K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness</atitle><jtitle>The American journal of psychiatry</jtitle><addtitle>Am J Psychiatry</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>174</volume><issue>4</issue><spage>370</spage><epage>377</epage><pages>370-377</pages><issn>0002-953X</issn><eissn>1535-7228</eissn><coden>AJPSAO</coden><abstract>Objective:The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior.Method:Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods.Results:Contingency management participants were 3.1 times (95% CI=2.2–4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up.Conclusions:This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.</abstract><cop>United States</cop><pub>American Psychiatric Association</pub><pmid>28135843</pmid><doi>10.1176/appi.ajp.2016.16050627</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Psychiatric Publishing Journals (1997-Present); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Alcohol use Alcoholism - epidemiology Alcoholism - psychology Alcoholism - therapy Alcoholism - urine Ambulatory Care Comorbidity Comparative analysis Diagnosis, Dual (Psychiatry) Female Follow-Up Studies Glucuronates - urine Humans Intervention Male Mental disorders Mental Disorders - blood Mental Disorders - epidemiology Mental Disorders - psychology Mental Disorders - therapy Mental health care Middle Aged Patient Compliance - psychology Token Economy |
| title | A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness |
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