A randomized controlled trial to assess whether a telehealth-based contingency management intervention reduces alcohol use for individuals with alcohol use disorder

Julianne D Jett; Diana Tyutyunnyk; Rachael Beck; Katharine Palmer; Danielle Ryan; Jesus Sanchez; Douglas L Weeks; Sterling M McPherson; Naomi Chaytor; Brian Kiluk; Martin A Javors; Brett C Ginsburg; Sean Murphy; Nathalie Hill-Kapturczak; Michael G McDonell

doi:10.1016/j.cct.2025.107807

A randomized controlled trial to assess whether a telehealth-based contingency management intervention reduces alcohol use for individuals with alcohol use disorder

Contemp Clin Trials. 2025 Jan 15:107807. doi: 10.1016/j.cct.2025.107807. Online ahead of print.

Authors

Affiliations

¹ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States of America. Electronic address: [email protected].
² Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States of America.
³ Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America.
⁴ Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, TX, USA.
⁵ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.

PMID: 39824379
DOI: 10.1016/j.cct.2025.107807

Abstract

Background: Contingency management (CM) is an intervention for alcohol use disorder (AUD) that reinforces abstinence, as confirmed by alcohol biomarkers. CM is usually brief (12-16 weeks) despite evidence that longer interventions have better long-term outcomes. Most CM models are in-person which can also be a barrier for treatment. Studies of longer duration telehealth-based CM models are needed.

Aims: To determine if a telehealth-based CM model that utilizes phosphatidylethanol (PEth) to confirm abstinence is effective at reducing alcohol use during a 26-week intervention and 12-month follow-up. We will evaluate the impact of CM on alcohol-related outcomes, determine if Addiction Neuroclinical Assessment variables are associated with outcomes in follow-up, and whether savings related to decreased alcohol use offset intervention costs.

Methods: Adults with AUD residing in the United States will be recruited via online advertising. Research procedures will be conducted virtually. Participants who submit a PEth-positive blood sample (≥20 ng/mL) at enrollment will be randomized to 26 weeks of either 1) online cognitive behavior therapy (CBT4CBT) with rewards not contingent on PEth results (Control group) or 2) CBT4CBT with a maximum of $1820 of rewards contingent on PEth results (CM group). Efficacy outcomes of PEth-negative tests (primary) and PEth-defined excessive drinking (≥200 ng/mL; secondary) will be assessed. Predictors of intervention outcomes and economic viability will also be investigated.

Discussion: If this telehealth-delivered PEth-based CM intervention reduces alcohol use and is cost-effective, it could be used to provide effective treatment to millions of individuals with AUD who do not receive in-person care.

Keywords: Addictions neuroclinical assessment framework; Alcohol use disorder (AUD); Contingency management (CM); Phosphatidylethanol (PEth); Telehealth; Urine ethyl glucuronide (uEtG).