Barnett Nancy P, Celio Mark A, Tidey Jennifer W, Murphy James G, Colby Suzanne M, Swift Robert M
Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
Department of Psychology, University of Memphis, Memphis, TN, USA.
Addiction. 2017 Jun;112(6):1025-1035. doi: 10.1111/add.13767. Epub 2017 Feb 22.
We tested the efficacy of daily contingent reinforcement for reducing alcohol use compared with (yoked) non-contingent reinforcement (NR) using a transdermal alcohol sensor to detect alcohol use.
Pilot randomized controlled design with 1 baseline week, 3 intervention weeks and 1-month follow-up.
New England, USA.
Heavy drinking adults (46.7% female) not seeking treatment were randomized to (1) an escalating schedule of cash reinforcement (CR; n = 15) for days on which alcohol was neither reported nor detected or (2) yoked NR (n = 15).
Reinforcement for CR participants started at $5 and increased $2 every subsequent day on which alcohol was not detected or reported, to a maximum of $17. Participants received no reinforcement for days on which alcohol use was detected or reported, and the reinforcer value was re-set to $5 the day after a drinking day. NR participants were yoked to the daily reinforcer value of an individual in the CR condition, in order of enrollment. Paired participants in CR and NR therefore received the same amount of money, but the amount for the NR participant was not behavior-related.
The primary outcome was percentage of days without sensor-detected drinking. Secondary outcomes were number of consecutive days with no detected drinking, peak transdermal alcohol concentration (TAC), self-reported drinks per week and drinking below NIH low-risk guidelines.
Controlling for baseline, CR had a higher percentage of days with no drinking detected (54.3%) than NR (31.2%) during intervention weeks [P = 0.05, Cohen's d = 0.74; 95% confidence interval (CI) = 0.007-1.47]. The longest period of consecutive days with no drinking detected was 8.0 for CR versus 2.9 for NR (P = 0.03, d = 0.85; 95% CI = 0.08-1.61). Peak TAC during intervention showed a non-significant group difference (P = 0.20; d = 0.48; 95% CI = 0.00-1.18); a similar result was found for drinks per week (P = 0.12; d = 0.59; 95% CI = 0.00-1.30). Four times more participants in CR drank below NIH low-risk drinking guidelines during intervention than did participants in NR: 31.1 versus 7.1% (P = 0.07; d = 0.71; 95% CI = -0.04 to 1.46). At 1-month follow-up, the highest number of consecutive days without drinking (self-report) did not differ significantly between conditions (P = 0.26), but showed a medium effect size (d = 0.44; 95% CI = -0.32 to 1.18).
Cash incentives linked to a transdermal alcohol sensor can reduce heavy alcohol consumption while the incentives are in operation.
我们使用经皮酒精传感器检测酒精使用情况，测试了每日偶然强化措施相较于（匹配的）非偶然强化措施（NR）在减少酒精使用方面的效果。
先导性随机对照设计，包括1周基线期、3周干预期和1个月随访期。
美国新英格兰地区。
未寻求治疗的重度饮酒成年人（女性占46.7%）被随机分为两组：（1）对于未报告且未检测到酒精使用的日子，采用逐步增加的现金强化计划（CR；n = 15）；（2）匹配的NR组（n = 15）。
CR组参与者的强化起始金额为5美元，在随后未检测到或未报告酒精使用的每一天增加2美元，最高可达17美元。在检测到或报告有酒精使用的日子，参与者没有强化奖励，且在饮酒日后一天，强化奖励金额重新设定为5美元。NR组参与者按照入组顺序与CR组个体的每日强化奖励金额相匹配。因此，CR组和NR组的配对参与者获得相同金额的钱，但NR组参与者获得的金额与行为无关。
主要结局是传感器未检测到饮酒的天数百分比。次要结局包括连续未检测到饮酒的天数、经皮酒精浓度峰值（TAC）、每周自我报告的饮酒量以及饮酒量低于美国国立卫生研究院低风险指南的情况。
在控制基线因素后，干预期内CR组未检测到饮酒的天数百分比（54.3%）高于NR组（31.2%）[P = 0.05，科恩d值 = 0.74；95%置信区间（CI）= 0.007 - 1.47]。CR组连续未检测到饮酒的最长天数为8.0天，而NR组为2.9天（P = 0.03，d = 0.85；95% CI = 0.08 - 1.61）。干预期内TAC峰值在两组间差异无统计学意义（P = 0.20；d = 0.48；95% CI = 0.00 - 1.18）；每周饮酒量的结果类似（P = 0.12；d = 0.59；95% CI = 0.00 - 1.30）。干预期间，CR组饮酒量低于美国国立卫生研究院低风险饮酒指南的参与者人数是NR组的4倍：分别为31.1%和7.1%（P = 0.07；d = 0.71；95% CI = -0.04至1.46）。在1个月随访时，两组间连续无饮酒（自我报告）的最长天数差异无统计学意义（P = 0.26），但显示出中等效应量（d = 0.44；95% CI = -0.32至1.18）。
与经皮酒精传感器相关联的现金激励措施在实施期间可减少重度酒精消费。
