Skip to main content
Full access
Articles
Published Online: 31 January 2017

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness

This article has been corrected.
VIEW CORRECTION

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.

Formats available

You can view the full content in the following formats:

Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 370 - 377
PubMed: 28135843

History

Received: 31 May 2016
Revision received: 17 August 2016
Accepted: 26 September 2016
Published online: 31 January 2017
Published in print: April 01, 2017

Keywords

  1. Alcohol Abuse
  2. Biological Markers
  3. Chronic Psychiatric Illness

Authors

Details

Michael G. McDonell, Ph.D.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Emily Leickly, B.A.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Sterling McPherson, Ph.D.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Jordan Skalisky, B.A.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Debra Srebnik, Ph.D.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Frank Angelo, M.A.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Roger Vilardaga, Ph.D.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Jenny R. Nepom, B.S., B.A.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
John M. Roll, Ph.D.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.
Richard K. Ries, M.D.
From the Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, Wash.; the Elson S. Floyd College of Medicine, Washington State University, Spokane, Wash.; the Program for Excellence in Addiction Research, Washington State University, Spokane, Wash.; the Providence Medical Research Center, Providence Health Care, Spokane, Wash.; the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Wash.; and the School of Public Health, University of Washington, Seattle, Wash.

Notes

Address correspondence to Dr. McDonell ([email protected]).

Competing Interests

Dr. McPherson has received research funding from the Bristol Myers Squibb Foundation. Dr. Vilardaga has received research funding from Pfizer. Dr. Roll has received research funding from the Bristol Myers Squibb Foundation. Dr. Ries has served on the speaker’s bureaus of Alkermes and Janssen. All other authors report no financial relationships with commercial interests.

Funding Information

National Institute on Alcohol Abuse and Alcoholism10.13039/100000027: R01 AA AA020248

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Full Text

View Full Text

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - American Journal of Psychiatry

PPV Articles - American Journal of Psychiatry

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share