Incentives program may reduce alcohol dependence in American Indian, Alaska Native adults
Providing tangible incentives for abstaining from alcohol may reduce alcohol dependence among American Indian and Alaska Native adults, according to results of a randomized clinical trial published in JAMA Psychiatry.
“Contingency management may be appealing to American Indian and Alaska Native communities because it provides encouragement to individuals seeking to reduce alcohol use, it can be easily modified to improve cultural acceptability, it does not require a licensed clinician for implementation, it can be added to ongoing care and it is inexpensive, with a typical cost of $300 to $500 per patient,” Michael G. McDonell, PhD, of the department of medical education and clinical sciences at Washington State University, and colleagues wrote. “Preparatory qualitative work indicated that contingency management was consistent with each community’s health priorities and values. Qualitative research suggested that contingency management should be adapted to include incentives that supported family relationships and integrated indigenous language and culture.”
The researchers aimed to determine whether adults in this patient population who received a contingency management intervention had higher levels of alcohol abstinence vs. those assigned to a control condition. The current Helping Our Native Ongoing Recovery study included a 1-month observation period before randomization, as well as a 3-month intervention period, and was conducted at three American Indian and Alaska Native health care organizations in Alaska, the Pacific Northwest and the Northern Plains across nearly 5 years. McDonell and colleagues included American Indian or Alaska Native adults with 1 or more days of high alcohol-use episodes within the past 30 days and a current diagnosis of alcohol dependence. A total of 75 participants were randomly assigned to the contingency management group in which they received 12 weeks of incentives for submitting a urine sample that indicated alcohol abstinence, and 83 were randomly assigned to the control group, in which they received 12 weeks of incentives for submitting a urine sample without having to indicate alcohol abstinence. The investigators assessed differences in abstinence during the intervention period using regression models fit with generalized estimating equations.
Results showed 19 (59.4%) participants in the intervention group submitted an alcohol-negative urine sample vs. 18 (38.3%) in the control group. Those who received contingency management were more likely to submit an alcohol-negative urine sample, averaged over time, vs. those in the control group (OR = 1.7; 95% CI, 1.05-2.76).
“This low cost, positive intervention was associated with reduced alcohol use in people,” McDonell told Healio Psychiatry. “Our adapted contingency intervention is a tool that American Indian/Alaska Native communities can use to help people with alcohol problems reduce their use.”