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Contingency management reduces alcohol abuse in co-occurring mental illness

A contingency management intervention that used ethyl glucuronide urine samples was significantly effective for individuals with alcohol use disorder and co-occurring serious mental illnesses.

“While contingency management is well established as an intervention for reducing drug use, few studies have investigated contingency management as a treatment for alcohol use disorders. This is primarily due to the lack of an alcohol biomarker that can verify abstinence for 2 days or more,” Michael G. McDonell, PhD, of Washington State University, Spokane, and colleagues wrote.

To assess efficacy of a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker for alcohol abstinence among individuals with co-occurring serious mental illnesses, researchers conducted a randomized controlled trial among 79 individuals with alcohol dependence and serious mental illness receiving outpatient treatment as usual. Study participants were randomly assigned to receive 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance or reinforcement only for study participation.

Contingency management consisted of varying levels of reinforcement “prize draw” three times per week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug testing and self-reports were conducted during the 12-week intervention and 3-month follow-up.

Participants who received contingency management were 3.1 times more likely to have EtG-negative urine tests and achieved approximately 1.5 weeks of additional alcohol abstinence, compared with controls.

Participants who received contingency management reported significantly lower mean EtG levels, less drinking and fewer heavy drinking episodes.

Further, participants who received contingency management were more likely to test negative for stimulants and smoking, compared with controls.

Differences in self-reported alcohol use remained at the 3-month follow-up.

“Results of this study strongly support the efficacy of an EtG-based contingency management intervention for alcohol use disorders,” the researchers wrote. “Group differences in alcohol use observed in this study and positive outcomes of our previous trial of contingency management targeting stimulant use suggest that contingency management may be a particularly effective intervention for those with co-occurring serious mental illness and substance use disorders, a high-cost and difficult-to-engage population.” – by Amanda Oldt

Disclosure: McDonell reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.