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Brobbin E, Parkin S, Deluca P, Drummond C. A qualitative exploration of the experiences of transdermal alcohol sensor devices amongst people in receipt of treatment for alcohol use disorder. Addict Behav Rep 2024; 19:100544. [PMID: 38596194 PMCID: PMC11002804 DOI: 10.1016/j.abrep.2024.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/04/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Transdermal alcohol sensors (TAS) have the potential to be used as a clinical tool in alcohol treatment, but there is limited research with individuals with alcohol dependence using TAS. Our study is a qualitative evaluation of the views of people attending alcohol treatment and their experiences of wearing the BACtrack Skyn, within alcohol services in South London. Methods Participants with alcohol dependence wore a BACtrack Skyn TAS for one week and met with the researcher every two days, for a total of four meetings (for example: Monday, Wednesday, Friday, and Monday). In the final meeting, a post-wear survey (on their physical, social and comfort experience of the TAS) and semi-structured interview were completed. The Technology Acceptance Model (TAM) informed the topic guide and data analysis. Results Adults (N = 16) receiving alcohol treatment were recruited. Three core topics guided analysis: perceived usefulness, perceived ease of use and attitudes towards use. Participants found the TAS easy to wear and felt positive about its appearance and comfort. The only challenges reported were side effects, mostly skin irritation. The main two perceived uses were 1) TAS working as a drinking deterrent and 2) reducing daily breathalyser visits during detox. Conclusion Findings support the use of TAS amongst alcohol service users. Wearing the TAS for one week was acceptable and feasible for objective alcohol concentration measurement. Participants reported high perceived ease of use and usefulness of the Skyn in the context of alcohol treatment. These results are encouraging for the use of TAS in clinical settings.
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Affiliation(s)
- Eileen Brobbin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Richards VL, Glenn SD, Turrisi RJ, Mallett KA, Ackerman S, Russell MA. Transdermal alcohol concentration features predict alcohol-induced blackouts in college students. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:880-888. [PMID: 38639884 PMCID: PMC11114374 DOI: 10.1111/acer.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Alcohol-induced blackouts (AIBs) are common in college students. Individuals with AIBs also experience acute and chronic alcohol-related consequences. Research suggests that how students drink is an important predictor of AIBs. We used transdermal alcohol concentration (TAC) sensors to measure biomarkers of increasing alcohol intoxication (rise rate, peak, and rise duration) in a sample of college students. We hypothesized that the TAC biomarkers would be positively associated with AIBs. METHODS Students were eligible to participate if they were aged 18-22 years, in their second or third year of college, reported drinking 4+ drinks on a typical Friday or Saturday, experienced ≥1 AIB in the past semester, owned an iPhone, and were willing to wear a sensor for 3 days each weekend. Students (N = 79, 55.7% female, 86.1% White, Mage = 20.1) wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). AIBs were assessed using the Alcohol-Induced Blackout Measure-2. Logistic multilevel models were conducted to test for main effects. RESULTS Days with faster TAC rise rates (OR = 2.69, 95% CI: 1.56, 5.90), higher peak TACs (OR = 2.93, 95% CI: 1.64, 7.11), and longer rise TAC durations (OR = 4.16, 95% CI: 2.08, 10.62) were associated with greater odds of experiencing an AIB. CONCLUSIONS In a sample of "risky" drinking college students, three TAC drinking features identified as being related to rising intoxication independently predicted the risk for daily AIBs. Our findings suggest that considering how an individual drinks (assessed using TAC biomarkers), rather than quantity alone, is important for assessing risk and has implications for efforts to reduce risk. Not only is speed of intoxication important for predicting AIBs, but the height of the peak intoxication and the time spent reaching the peak are important predictors, each with different implications for prevention.
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Affiliation(s)
- Veronica L. Richards
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shannon D. Glenn
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert J. Turrisi
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly A. Mallett
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah Ackerman
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michael A. Russell
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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Craig AR, Agnew CN, Derrenbacker KE, Antúnez BA, Sullivan WE, Smith SW, DeBartelo J, Roane HS. Resurgence of ethanol seeking following voluntary abstinence produced by nondrug differential reinforcement of other behavior. J Exp Anal Behav 2024; 121:314-326. [PMID: 38499477 DOI: 10.1002/jeab.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/11/2024] [Indexed: 03/20/2024]
Abstract
Resurgence refers to the relapse of a target behavior following the worsening of a source of alternative reinforcement that was made available during response elimination. Most laboratory analyses of resurgence have used a combination of extinction and alternative reinforcement to reduce target behavior. In contingency-management treatments for alcohol use disorder, however, alcohol use is not placed on extinction. Instead, participants voluntarily abstain from alcohol use to access nondrug alternative reinforcers. Inasmuch, additional laboratory research on resurgence following voluntary abstinence is warranted. The present experiment evaluated resurgence of rats' ethanol seeking following voluntary abstinence produced by differential reinforcement of other behavior (DRO). Lever pressing produced ethanol reinforcers during baseline phases. During DRO phases, lever pressing continued to produce ethanol and food reinforcers were delivered according to resetting DRO schedules. Ethanol and food reinforcers were suspended during resurgence test phases to evaluate resurgence following voluntary abstinence. Lever pressing was elevated during baseline phases and occurred at near-zero rates during DRO phases. During the resurgence test phases, lever pressing increased, despite that it no longer produced ethanol. The procedure introduced here may help researchers better understand the variables that affect voluntary abstinence from ethanol seeking and resurgence following voluntary abstinence.
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Affiliation(s)
- Andrew R Craig
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Charlene N Agnew
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kate E Derrenbacker
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Beatriz Arroyo Antúnez
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
- Centro de Estudios e Investigaciones en Comportamiento, Universidad de Guadalajara, Jalisco, Mexico
| | - William E Sullivan
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Sean W Smith
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jacqueline DeBartelo
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Henry S Roane
- Golisano Center for Special Needs, SUNY Upstate Medical University, Syracuse, NY, USA
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Cook RL, Richards VL, Gullett JM, Lerner BDG, Zhou Z, Porges EC, Wang Y, Kahler CW, Barnett NP, Li Z, Pallikkuth S, Thomas E, Rodriguez A, Bryant KJ, Ghare S, Barve S, Govind V, Dévieux JG, Cohen RA. Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial. JMIR Res Protoc 2024; 13:e53684. [PMID: 38564243 PMCID: PMC11028398 DOI: 10.2196/53684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. OBJECTIVE The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. METHODS The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. RESULTS We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. CONCLUSIONS This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. TRIAL REGISTRATION ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53684.
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Affiliation(s)
- Robert L Cook
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Veronica L Richards
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States
| | - Joseph M Gullett
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | | | - Zhi Zhou
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Eric C Porges
- Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL, United States
| | - Yan Wang
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Zhigang Li
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Suresh Pallikkuth
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emmanuel Thomas
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Allan Rodriguez
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Smita Ghare
- Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Shirish Barve
- Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Varan Govind
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Ronald A Cohen
- Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL, United States
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Wang Y, Porges EC, DeFelice J, Fridberg DJ. Integrating Alcohol Biosensors With Ecological Momentary Intervention (EMI) for Alcohol Use: a Synthesis of the Latest Literature and Directions for Future Research. CURRENT ADDICTION REPORTS 2024; 11:191-198. [PMID: 38854904 PMCID: PMC11155371 DOI: 10.1007/s40429-024-00543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 06/11/2024]
Abstract
Purpose of Review Excessive alcohol use is a major public health concern. With increasing access to mobile technology, novel mHealth approaches for alcohol misuse, such as ecological momentary intervention (EMI), can be implemented widely to deliver treatment content in real time to diverse populations. This review summarizes the state of research in this area with an emphasis on the potential role of wearable alcohol biosensors in future EMI/just-in-time adaptive interventions (JITAI) for alcohol use. Recent Findings JITAI emerged as an intervention design to optimize the delivery of EMI for various health behaviors including substance use. Alcohol biosensors present an opportunity to augment JITAI/EMI for alcohol use with objective information on drinking behavior captured passively and continuously in participants' daily lives, but no prior published studies have incorporated wearable alcohol biosensors into JITAI for alcohol-related problems. Several methodological advances are needed to accomplish this goal and advance the field. Future research should focus on developing standardized data processing, analysis, and interpretation methods for wrist-worn biosensor data. Machine learning algorithms could be used to identify risk factors (e.g., stress, craving, physical locations) for high-risk drinking and develop decision rules for interpreting biosensor-derived transdermal alcohol concentration (TAC) data. Finally, advanced trial design such as micro-randomized trials (MRT) could facilitate the development of biosensor-augmented JITAI. Summary Wrist-worn alcohol biosensors are a promising potential addition to improve mHealth and JITAI for alcohol use. Additional research is needed to improve biosensor data analysis and interpretation, build new machine learning models to facilitate integration of alcohol biosensors into novel intervention strategies, and test and refine biosensor-augmented JITAI using advanced trial design.
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Affiliation(s)
- Yan Wang
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Eric C. Porges
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Jason DeFelice
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Daniel J. Fridberg
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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Dionisi T, Di Sario G, De Mori L, Spagnolo G, Antonelli M, Tarli C, Sestito L, Mancarella FA, Ferrarese D, Mirijello A, Vassallo GA, Gasbarrini A, Addolorato G. Current treatments of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:127-152. [PMID: 38555114 DOI: 10.1016/bs.irn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Emerging treatments for alcohol dependence reveal an intricate interplay of neurobiological, psychological, and circumstantial factors that contribute to Alcohol Use Disorder (AUD). The approved strategies balancing these factors involve extensive manipulations of neurotransmitter systems such as GABA, Glutamate, Dopamine, Serotonin, and Acetylcholine. Innovative developments are engaging mechanisms such as GABA reuptake inhibition and allosteric modulation. Closer scrutiny is placed on the role of Glutamate in chronic alcohol consumption, with treatments like NMDA receptor antagonists and antiglutamatergic medications showing significant promise. Complementing these neurobiological approaches is the progressive shift towards Personalized Medicine. This strategy emphasizes unique genetic, epigenetic and physiological factors, employing pharmacogenomic principles to optimize treatment response. Concurrently, psychological therapies have become an integral part of the treatment landscape, tackling the cognitive-behavioral dimension of addiction. In instances of AUD comorbidity with other psychiatric disorders, Personalized Medicine becomes pivotal, ensuring treatment and prognosis are closely defined by individual characteristics, as exemplified by Lesch Typology models. Given the high global prevalence and wide distribution of AUD, a persistent necessity exists for development and improvement of treatments. Current research efforts are steadily paving paths towards more sophisticated, effective typology-based treatments: a testament to the recognized imperative for enhanced treatment strategies. The potential encapsulated within the ongoing research suggests a promising future where the clinical relevance of current strategies is not just maintained but significantly improved to effectively counter alcohol dependence.
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Affiliation(s)
- Tommaso Dionisi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Giovanna Di Sario
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Lorenzo De Mori
- Department of Neuroscience, Section of Psychiatry, Catholic University of Rome, Rome, Italy
| | - Giorgia Spagnolo
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Mariangela Antonelli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Sestito
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Antonio Mancarella
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Ferrarese
- Clinical Psychology Unit, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy
| | - Antonio Mirijello
- Unit of Internal Medicine, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | | | - Antonio Gasbarrini
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS "A. Gemelli" University Polyclinic Foundation, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy.
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Brobbin E, Deluca P, Coulton S, Parkin S, Drummond C. Comparison of transdermal alcohol concentration and self-reported alcohol consumption in people with alcohol dependence attending community alcohol treatment services. Drug Alcohol Depend 2024; 256:111122. [PMID: 38367536 DOI: 10.1016/j.drugalcdep.2024.111122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
AIM We aimed to assess the accuracy and wearability of a transdermal alcohol sensor (TAS) (BACtrack Skyn) with people currently receiving treatment at alcohol services. METHOD A mixed methods observational study involving three NHS alcohol services in south London was conducted. All participants (7=male, 9=female) wore a TAS for 1 week and met with the researcher every other weekday to complete the TAS data download and a TimeLine Follow Back (TLFB). At the end of the week, a post-wear survey was completed. Transdermal Alcohol Concentration (TAC) from the TAS was compared to the TLFB. Post-wear survey responses, attendance voucher incentives and descriptive TAS data (removals, missing and skin temperature data) were analysed. We investigated different drinking event thresholds changing the criteria of TAC level and length of time TAC was increased and analysed each drinking threshold sensitivity, specificity, positive and negative predicative values, and percentage accuracy classification. RESULTS The TAS recorded the number of alcohol-drinking days with a high degree of accuracy compared to the TLFB as gold-standard. However, of the participation time of the 16 participants, 14.5% of the TAS data was missing in output and 16.4% of the recorded data suggests the TAS was not currently being worn. Of the data recorded, in line with the drinking event threshold of >15 ug/l TAC, >15minutes, we found that sensitivity = 93%, specificity = 84% and a Pearson correlation of r(16) =.926, p = <.001, BCa 95% CI [.855 -.981]. The threshold with the highest accuracy was TAC>15 ug/l, >60minutes which classified alcohol events with 90% accuracy, AUC =.910, sensitivity = 90%, specificity = 96%. The post-wear survey reported that most participants found it comfortable and that wearing it did not interfere with daily activities. Six participants reported side effects, including itching and a rash, but these would not deter them from wearing it again with all six reporting they would wear the TAS again and for longer than one week. CONCLUSIONS The TAS did not capture every drinking event that was self-reported but maintained a high correlation. There were instances of missing TAS data and TAS removals. Overall, our findings would support the acceptability and feasibility of TAS as a tool that could be used in clinical settings for objective alcohol monitoring with patients being responsible for the TAS.
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Affiliation(s)
- Eileen Brobbin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Brobbin E, Deluca P, Coulton S, Drummond C. Accuracy of transdermal alcohol monitoring devices in a laboratory setting. Alcohol Alcohol 2024; 59:agad068. [PMID: 37873967 DOI: 10.1093/alcalc/agad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
The development of transdermal alcohol sensors (TASs) presents a new method to monitor alcohol consumption with the ability to objectively measure data 24/7. We aimed to evaluate the accuracy of two TASs (BACtrack Skyn and Smart Start BARE) in a laboratory setting. Thirty-two adults received a dose of ethanol 0.56 g/kg body weight as a 20% solution while wearing the two TASs and provided Breath Alcohol Concentration (BrAC) measurements for 3.5 h postalcohol consumption. Pearson's correlations and repeated measures analysis of variance tests were conducted on the peak, time-to-peak, and area under the curve data. Bland-Altman plots were derived. A time series analysis and cross-correlations were conducted to adjust for time lag. Both TASs were able to detect alcohol and increase within 20 min. BrAC peaked significantly quicker than Skyn and BARE. BrAC and Skyn peaks were negatively significantly correlated (r = -0.381, P = .035, n = 31), while Skyn and BARE peaks were positively significantly correlated (r = 0.380, P = .038, n = 30). Repeated measures analysis of variance found a significant difference between BrAC, Skyn, and BARE (F(1.946, 852.301) = 459.873, P < .001)). A time series analysis found when BrAC-Skyn and BrAC-BARE were adjusted for the delay to peak, and there was still a significant difference. Failure rates: 1.7% (Skyn) and 4.8% (BARE). Some evidence was obtained for TAS validity as both consistently detected alcohol. Failure rates and time lag show improvements in older device generations. However, neither TAS presented strong equivalence to the breathalyser even when the lag time was adjusted. With further testing and technology advancements, TAS could be a potential alcohol monitoring tool. Two of the newest TAS devices were worn in laboratory conditions for one afternoon to compare their accuracy of alcohol monitoring to a breathalyser. Findings suggest that the two TASs (BACtrack Skyn and SmartStart BARE) recorded significantly similar data postalcohol consumption, but not with the breathalyser.
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Affiliation(s)
- Eileen Brobbin
- Addiction Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom
| | - Paolo Deluca
- Addiction Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury CT2 7NF, United Kingdom
| | - Colin Drummond
- Addiction Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom
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Hallihan H, Abboud S, Lee S, Rospenda K, Srimoragot M, Fink A, Ma J. A qualitative exploration of young adults' perceptions of a new intervention for alcohol use disorder. Ann Med 2024; 55:2295983. [PMID: 38175792 PMCID: PMC10769559 DOI: 10.1080/07853890.2023.2295983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Due to the rising prevalence of alcohol use disorders among young adults, the need for effective and accessible interventions has become increasingly imperative. In acknowledgment of this issue, we developed a novel intervention known as contingency management plus problem solving therapy (CM-PST). The aim of the current study was to gain insight into the perspectives on the effectiveness of the newly developed CM-PST using focus group discussion among young adults who consume alcohol regularly. MATERIALS AND METHODS The study employed a qualitative research design, utilizing focus group discussions as the primary data collection method. Participants described their perceptions regarding the newly developed CM-PST. Semi-structured focus group sessions were conducted via Zoom in November 2022. A total of 19 young adults, aged 18-24 years old, participated in five focus group sessions. Data were analyzed using deductive content analysis. RESULTS Participants demonstrated overall positive attitudes toward the novel intervention, recognizing the potential benefits, it could offer in terms of alcohol use reduction and emotional well-being. They emphasized the importance of incentives in motivating behavioral changes, as well as the practicality of problem-solving techniques in addressing everyday challenges. Additionally, participants provided valuable insights into potential barriers and implementation challenges, highlighting the need for flexible and personalized approaches to accommodate individual preferences and needs. CONCLUSIONS The results of this study contribute to the growing body of literature on innovative intervention approaches for young adults facing alcohol use issues. The findings shed light on the acceptability and perceived effectiveness of the CM-PST intervention from the perspective of the target population.
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Affiliation(s)
- Hagar Hallihan
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Sangeun Lee
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Kathleen Rospenda
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | | | - Anne Fink
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, IL, USA
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Richards VL, Wang Y, Porges EC, Gullett JM, Leeman RF, Zhou Z, Barnett NP, Cook RL. Using alcohol biosensors and biomarkers to measure changes in drinking: Associations between transdermal alcohol concentration, phosphatidylethanol, and self-report in a contingency management study of persons with and without HIV. Exp Clin Psychopharmacol 2023; 31:991-997. [PMID: 36649152 PMCID: PMC10349895 DOI: 10.1037/pha0000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Alcohol use can be measured in many ways, including objectively through transdermal alcohol biosensors (e.g., transdermal alcohol concentration; TAC) or blood biomarkers (e.g., phosphatidylethanol; PEth), or subjectively through self-report (e.g., with the timeline followback; TLFB). However, it is unclear which measures best indicate changes in alcohol use within individuals following intervention, and if they have concurrent validity. In the context of contingency management (CM) with a goal of 30-day abstinence (n = 45, 60% male, 80% Black; Mage = 56.7; 58% with HIV), we examined relationships among changes in TAC-AUC (area under the curve, reflecting volume consumed), PEth, and self-reported number of drinks. The Secure Continuous Remote Alcohol Monitor Continuous Alcohol Monitoring (SCRAM-CAM) biosensor was used to collect TAC-AUC during a pre-CM period (∼7 days) and over a 30-day CM period. PEth was collected at baseline and 30-day follow-up. Number of drinks was self-reported through a 30-day TLFB at baseline and follow-up. Daily TAC-AUC and number of self-reported drinks were calculated for the pre-CM period and for the last 7 days of the CM period. Linear regression models controlling for baseline values revealed that change in TAC-AUC was significantly associated with change in PEth (β = 0.33, p < .0001) and with change in number of self-reported drinks (β = 0.34, p < .0001). Change in PEth was significantly associated with change in number of self-reported drinks (β = 0.85, p < .0001). We conclude that all three measures may be appropriate for measuring within-person change in alcohol use, while controlling for baseline values, in the context of a study testing an intervention such as CM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Veronica L. Richards
- Department of Epidemiology, University of Florida
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University
| | - Yan Wang
- Department of Epidemiology, University of Florida
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, University of Florida
- Department of Clinical and Health Psychology, University of Florida
- McKnight Brain Research Foundation, University of Florida
| | - Joseph M. Gullett
- Center for Cognitive Aging and Memory, University of Florida
- Department of Clinical and Health Psychology, University of Florida
- McKnight Brain Research Foundation, University of Florida
| | - Robert F. Leeman
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University
- Department of Health Education & Behavior, University of Florida
| | - Zhi Zhou
- Department of Epidemiology, University of Florida
| | - Nancy P. Barnett
- Department of Behavioral and Social Sciences, Brown University School of Public Health
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11
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Dallery J, Ives L, Knerr A. Toward an era of impact of digital contingency management in the treatment of substance use disorders. Prev Med 2023; 176:107518. [PMID: 37080501 DOI: 10.1016/j.ypmed.2023.107518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 04/22/2023]
Abstract
Digital contingency management entails remote methods to obtain biochemical confirmation of drug status and provide desirable, tangible consequences contingent on abstinence. Advances in digital CM suggest that it may be on the cusp of making a public health impact. Specific advances include technological capabilities and affordability, companies that specialize in digital CM, policies and reimbursement models, and the increasing availability of resources related to CM. Digital CM has expanded from cigarette smoking to alcohol and illicit substance misuse, and to include a diverse range of underserved and high-risk groups (e.g., pregnant and postpartum women, socioeconomically disadvantaged individuals, adolescents, and rural populations). Although the digital divide continues to narrow, culturally responsive methods may increase uptake and engagement with digital CM. The promise of digital CM is widescale access to an evidence-based treatment with low staff burden, no side effects, high fidelity engagement, acceptability, and effectiveness, and greater equity. We may be close to realizing this promise.
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12
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Novak MD, Toegel F, Holtyn AF, Rodewald AM, Arellano M, Baranski M, Barnett NP, Leoutsakos JM, Fingerhood M, Silverman K. Abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder: A randomized clinical trial. Prev Med 2023; 176:107655. [PMID: 37541600 PMCID: PMC10837308 DOI: 10.1016/j.ypmed.2023.107655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting alcohol abstinence and employment in adults experiencing homelessness and alcohol use disorder. A randomized clinical trial was conducted from 2019 to 2022. After a 1-month Induction period, 119 participants were randomly assigned to a Usual Care Control group (n = 57) or an Abstinence-Contingent Wage Supplement group (n = 62). Usual Care participants were offered counseling and referrals to employment and treatment programs. Abstinence-Contingent Wage Supplement participants could earn stipends for working with an employment specialist and wage supplements for working in a community job but had to maintain abstinence from alcohol as determined by transdermal alcohol concentration monitoring devices to maximize pay. Abstinence-Contingent Wage Supplement participants reported significantly higher rates of alcohol abstinence than Usual Care participants during the 6-month intervention (82.8% vs. 60.2% of months, OR = 3.4, 95% CI 1.8 to 6.3, p < .001). Abstinence-Contingent Wage Supplement participants were also significantly more likely to obtain employment (51.3% vs. 31.6% of months, OR = 2.6, 95% CI 1.5 to 4.4, p < .001) and live out of poverty (38.2% vs. 16.7% of months, OR = 3.7, 95% CI 2.0 to 7.1, p < .001) than Usual Care participants. These findings suggest that Abstinence-Contingent Wage Supplements can promote alcohol abstinence and employment in adults experiencing homelessness and alcohol use disorder. ClinicalTrials.gov Identifier: NCT03519009.
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Affiliation(s)
- Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Psychological Science, Northern Michigan University, Marquette, MI, United States
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meghan Arellano
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mackenzie Baranski
- Department of Psychological Science, Northern Michigan University, Marquette, MI, United States
| | - Nancy P Barnett
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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13
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Donoghue K, Boniface S, Brobbin E, Byford S, Coleman R, Coulton S, Day E, Dhital R, Farid A, Hermann L, Jordan A, Kimergård A, Koutsou ML, Lingford-Hughes A, Marsden J, Neale J, O'Neill A, Phillips T, Shearer J, Sinclair J, Smith J, Strang J, Weinman J, Whittlesea C, Widyaratna K, Drummond C. Adjunctive Medication Management and Contingency Management to enhance adherence to acamprosate for alcohol dependence: the ADAM trial RCT. Health Technol Assess 2023; 27:1-88. [PMID: 37924307 PMCID: PMC10641712 DOI: 10.3310/dqkl6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Acamprosate is an effective and cost-effective medication for alcohol relapse prevention but poor adherence can limit its full benefit. Effective interventions to support adherence to acamprosate are therefore needed. Objectives To determine the effectiveness of Medication Management, with and without Contingency Management, compared to Standard Support alone in enhancing adherence to acamprosate and the impact of adherence to acamprosate on abstinence and reduced alcohol consumption. Design Multicentre, three-arm, parallel-group, randomised controlled clinical trial. Setting Specialist alcohol treatment services in five regions of England (South East London, Central and North West London, Wessex, Yorkshire and Humber and West Midlands). Participants Adults (aged 18 years or more), an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of alcohol dependence, abstinent from alcohol at baseline assessment, in receipt of a prescription for acamprosate. Interventions (1) Standard Support, (2) Standard Support with adjunctive Medication Management provided by pharmacists via a clinical contact centre (12 sessions over 6 months), (3) Standard Support with adjunctive Medication Management plus Contingency Management that consisted of vouchers (up to £120) to reinforce participation in Medication Management. Consenting participants were randomised in a 2 : 1 : 1 ratio to one of the three groups using a stratified random permuted block method using a remote system. Participants and researchers were not blind to treatment allocation. Main outcome measures Primary outcome: self-reported percentage of medication taken in the previous 28 days at 6 months post randomisation. Economic outcome: EuroQol-5 Dimensions, a five-level version, used to calculate quality-adjusted life-years, with costs estimated using the Adult Service Use Schedule. Results Of the 1459 potential participants approached, 1019 (70%) were assessed and 739 (73 consented to participate in the study, 372 (50%) were allocated to Standard Support, 182 (25%) to Standard Support with Medication Management and 185 (25%) to Standard Support and Medication Management with Contingency Management. Data were available for 518 (70%) of participants at 6-month follow-up, 255 (68.5%) allocated to Standard Support, 122 (67.0%) to Standard Support and Medication Management and 141 (76.2%) to Standard Support and Medication Management with Contingency Management. The mean difference of per cent adherence to acamprosate was higher for those who received Standard Support and Medication Management with Contingency Management (10.6%, 95% confidence interval 19.6% to 1.6%) compared to Standard Support alone, at the primary end point (6-month follow-up). There was no significant difference in per cent days adherent when comparing Standard Support and Medication Management with Standard Support alone 3.1% (95% confidence interval 12.8% to -6.5%) or comparing Standard Support and Medication Management with Standard Support and Medication Management with Contingency Management 7.9% (95% confidence interval 18.7% to -2.8%). The primary economic analysis at 6 months found that Standard Support and Medication Management with Contingency Management was cost-effective compared to Standard Support alone, achieving small gains in quality-adjusted life-years at a lower cost per participant. Cost-effectiveness was not observed for adjunctive Medication Management compared to Standard Support alone. There were no serious adverse events related to the trial interventions reported. Limitations The trial's primary outcome measure changed substantially due to data collection difficulties and therefore relied on a measure of self-reported adherence. A lower than anticipated follow-up rate at 12 months may have lowered the statistical power to detect differences in the secondary analyses, although the primary analysis was not impacted. Conclusions Medication Management enhanced with Contingency Management is beneficial to patients for supporting them to take acamprosate. Future work Given our findings in relation to Contingency Management enhancing Medication Management adherence, future trials should be developed to explore its effectiveness and cost-effectiveness with other alcohol interventions where there is evidence of poor adherence. Trial registration This trial is registered as ISRCTN17083622 https://doi.org/10.1186/ISRCTN17083622. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim Donoghue
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Sadie Boniface
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Institute of Alcohol Studies, London, UK
| | - Eileen Brobbin
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King's Health Economics, King's College London, London UK
| | - Rachel Coleman
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Edward Day
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Ranjita Dhital
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Arts and Sciences Department, University College London, London, UK
| | - Anum Farid
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- What Works for Children's Social Care, London, UK
| | - Laura Hermann
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Amy Jordan
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Black Country Healthcare NHS Foundation Trust, West Bromwich, UK
| | - Andreas Kimergård
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | | | - Anne Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - John Marsden
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Joanne Neale
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Aimee O'Neill
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Phillips
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - James Shearer
- Institute of Psychiatry, Psychology and Neuroscience, King's Health Economics, King's College London, London UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joanna Smith
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - John Strang
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Kideshini Widyaratna
- Institute of Psychiatry Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
| | - Colin Drummond
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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14
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Dougherty DM, Moon TJ, Liang Y, Roache JD, Lamb RJ, Mathias CW, Wasserman AM, Wood EE, Hill-Kapturczak N. Effectiveness of contingency management using transdermal alcohol monitoring to reduce heavy drinking among driving while intoxicated (DWI) arrestees: A randomized controlled trial. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1989-2001. [PMID: 37864527 PMCID: PMC11205128 DOI: 10.1111/acer.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Driving while intoxicated (DWI) is a serious public health problem. However, treatment for DWI arrestees is not readily available. This study examines the effectiveness of a contingency management (CM) procedure using transdermal alcohol concentration (TAC) monitoring to reduce drinking among DWI arrestees. METHOD The study participants were 216 DWI arrestees under pretrial and included both Mandated participants undergoing court-ordered TAC monitoring and Non-Mandated participants wearing a study-provided TAC monitor. Participants were randomly assigned to either a CM (Mandated = 35; Non-Mandated = 74) or a Control condition (Mandated = 37; Non-Mandated = 70) and completed the 8-week intervention. CM participants received $50/week for not exceeding a TAC of 0.02 g/dL during the previous week. Payments to Controls were yoked to the CM group. RESULTS Among Non-Mandated participants, the probability of meeting the contingency was higher and remained stable (about 65%) over time in the CM group, whereas the probability was lower and declined in the Control group, widening the gaps in the probability between the study conditions (16.7%-24.1% greater in the CM group from visit 4 to 8, all p < 0.05). Among Mandated participants, the probability was not significantly different between conditions (p = 0.06-0.95). Furthermore, among Non-Mandated participants, the percentage of heavy drinking days remained low (9.16%-11.37%) in the CM group, whereas it was greater and increased over time (17.43%-26.59%) in the Control group. In Mandated participants, no significant differences in percent heavy drinking days were observed between conditions (p = 0.07-0.10). CONCLUSION We found that contingency effects on alcohol use are more pronounced among frequent and heavy alcohol users, i.e., Non-Mandated DWI arrestees. However, for individuals whose drinking was already suppressed by existing contingencies (i.e., court-mandated TAC monitoring), our CM procedure did not produce additional reductions in drinking.
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Affiliation(s)
| | - Tae-Joon Moon
- Department of Health, Behavior, and Society, University of Texas School of Public Health San Antonio, San Antonio, Texas, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - John D. Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard J. Lamb
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Charles W. Mathias
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Erin E. Wood
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Nathalie Hill-Kapturczak
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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15
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Courtney JB, Russell MA, Conroy DE. Acceptability and validity of using the BACtrack skyn wrist-worn transdermal alcohol concentration sensor to capture alcohol use across 28 days under naturalistic conditions - A pilot study. Alcohol 2023; 108:30-43. [PMID: 36473634 PMCID: PMC10413177 DOI: 10.1016/j.alcohol.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/09/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Wrist-worn transdermal alcohol concentration (TAC) sensors have the potential to provide detailed information about day-level features of alcohol use but have rarely been used in field-based research or in early adulthood (i.e., 26-40 years) alcohol users. This pilot study assessed the acceptability, user burden, and validity of using the BACtrack Skyn across 28 days in individuals' natural settings. Adults aged 26-37 (N = 11, Mage = 31.2, 55% female, 73% non-Hispanic white) participated in a study including retrospective surveys, a 28-day field protocol wearing Skyn and SCRAM sensors and completing ecological momentary assessments (EMA) of alcohol use and duration (daily morning reports and participant-initiated start/stop drinking EMAs), and follow-up interviews. Day-level features of alcohol use extracted from self-reports and/or sensors included drinks consumed, estimated Blood Alcohol Concentration (eBAC), drinking duration, peak TAC, area under the curve (AUC), rise rate, and fall rate. Repeated-measures correlations (rrm) tested within-person associations between day-level features of alcohol use from the Skyn versus self-report or the SCRAM. Participants preferred wearing the Skyn over the SCRAM [t (10) = -6.79, p < .001, d = 2.74]. Skyn data were available for 5614 (74.2%) out of 7566 h, with 20.7% of data lost due to syncing/charging issues and 5.1% lost due to device removal. Skyn agreement for detecting drinking days was 55.5% and 70.3% when compared to self-report and the SCRAM, respectively. Correlations for drinking intensity between self-report and the Skyn were 0.35 for peak TAC, 0.52 for AUC, and 0.30 for eBAC, which were smaller than correlations between self-report and SCRAM, at 0.78 for peak TAC, 0.79 for AUC, and 0.61 for eBAC. Correlations for drinking duration were larger when comparing self-report to the Skyn (rrm = 0.36) versus comparing self-report to the SCRAM (rrm = 0.31). The Skyn showed moderate-to-large, significant correlations with the SCRAM for peak TAC (rrm = 0.54), AUC (rrm = 0.80), and drinking duration (rrm = 0.63). Our findings support the acceptability and validity of using the Skyn for assessing alcohol use across an extended time frame (i.e., 28 days) in individuals' natural settings, and for providing useful information about day-level features of alcohol use.
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Affiliation(s)
- Jimikaye B Courtney
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, 16802, United States.
| | - Michael A Russell
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, 16802, United States
| | - David E Conroy
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, 16802, United States
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16
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Coughlin LN, Salino S, Jennings C, Lacek M, Townsend W, Koffarnus MN, Bonar EE. A systematic review of remotely delivered contingency management treatment for substance use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208977. [PMID: 36804352 PMCID: PMC10936237 DOI: 10.1016/j.josat.2023.208977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/23/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Substance use and related consequences (e.g., impaired driving, injuries, disease transmission) continue to be major public health concerns. Contingency management (CM) is a highly effective treatment for substance use disorders. Yet CM remains vastly underutilized, in large part due to implementation barriers to in-person delivery. If feasible and effective, remote delivery of CM may reduce barriers at both the clinic- and patient-level, thus increasing reach and access to effective care. Here, we summarize data from a systematic review of studies reporting remote delivery of CM for substance use treatment. METHODS We conducted a systematic review, reported according to PRISMA guidelines. The study team identified a total of 4358 articles after deduplication. Following title and abstract screening, full-text screening, and reference tracking, 39 studies met the eligibility criteria. We evaluated the methodological quality of the included studies using the Effective Public Health Practice Project Quality tool. RESULTS Of 39 articles included in the review, most (n = 26) targeted cigarette smoking, with others focusing on alcohol (n = 9) or other substance use or targeting multiple substances (n = 4). Most remotely delivered CM studies focused on abstinence (n = 29), with others targeting substance use reduction (n = 2), intervention engagement (n = 5), and both abstinence and intervention engagement (n = 3). CM was associated with better outcomes (either abstinence, use reduction, or engagement), with increasingly more remotely delivered CM studies published in more recent years. Studies ranged from moderate to strong quality, with the majority (57.5 %) of studies being strong quality. CONCLUSIONS Consistent with in-person CM, remotely delivered CM focusing on abstinence or use reduction from substances or engagement in substance use treatment services improves outcomes at the end of treatment compared to control conditions. Moreover, remotely delivered CM is feasible across a variety of digital delivery platforms (e.g., web, mobile, and wearable), with acceptability and reduced clinic and patient burden as technological advancements streamline monitoring and reinforcer delivery.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Sarah Salino
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Claudia Jennings
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Madelyn Lacek
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mikhail N Koffarnus
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA
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17
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Richards VL, Barnett NP, Cook RL, Leeman RF, Souza T, Case S, Prins C, Cook C, Wang Y. Correspondence between alcohol use measured by a wrist-worn alcohol biosensor and self-report via ecological momentary assessment over a 2-week period. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:308-318. [PMID: 36507857 PMCID: PMC9992096 DOI: 10.1111/acer.14995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transdermal alcohol biosensors measure alcohol use continuously, passively, and non-invasively. There is little field research on the Skyn biosensor, a new-generation, wrist-worn transdermal alcohol biosensor, and little evaluation of its sensitivity and specificity and the day-level correspondence between transdermal alcohol concentration (TAC) and number of self-reported drinks. METHODS Participants (N = 36; 61% male, M age = 34.3) wore the Skyn biosensor and completed ecological momentary assessment (EMA) surveys about their alcohol use over 2 weeks. A total of 497 days of biosensor and EMA data were collected. Skyn-measured drinking episodes were defined by TAC > 5 μg/L. Skyn data were compared to self-reported drinking to calculate sensitivity and specificity (for drinking day vs. nondrinking day). Generalized estimating equations models were used to evaluate the correspondence between TAC features (peak TAC and TAC-area under the curve (AUC)) and number of drinks. Individual-level factors (sex, age, race/ethnicity, body mass index, human immunodeficiency virus status, and hazardous drinking) were examined to explore associations with TAC controlling for number of drinks. RESULTS Using a minimum TAC threshold of 5 μg/L plus coder review, the biosensor had sensitivity of 54.7% and specificity of 94.6% for distinguishing drinking from nondrinking days. Without coder review, the sensitivity was 78.1% and the specificity was 55.2%. Peak TAC (β = 0.92, p < 0.0001) and TAC-AUC (β = 1.60, p < 0.0001) were significantly associated with number of drinks. Females had significantly higher TAC levels than males for the same number of drinks. CONCLUSIONS Skyn-derived TAC can be used to measure alcohol use under naturalistic drinking conditions, additional research is needed to accurately identify drinking episodes based on Skyn TAC readings.
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Affiliation(s)
- Veronica L. Richards
- Department of Epidemiology, College of Public Health and Health Profession and College of Medicine, University of Florida, Gainesville, Florida, USA
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Profession and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert F. Leeman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Timothy Souza
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stuart Case
- Department of Epidemiology, College of Public Health and Health Profession and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Cindy Prins
- Department of Epidemiology, College of Public Health and Health Profession and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Yan Wang
- Department of Epidemiology, College of Public Health and Health Profession and College of Medicine, University of Florida, Gainesville, Florida, USA
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18
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Courtney JB, Russell MA. To Drink or Not to Drink: Is That the Question? Examining Correspondence and Predictive Validity of Morning Drinking Intentions for Young Adults' Drinking Behaviors and Consequences. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:322-336. [PMID: 36155882 PMCID: PMC9957811 DOI: 10.1007/s11121-022-01437-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/26/2022]
Abstract
The Theory of Planned Behavior suggests that intentions are significant and proximal determinants of behavior. The purpose of this study was to test the predictive validity of drinking intentions for subsequent same-day drinking behaviors and negative consequences. Regularly drinking young adults (N = 222, 21-29 years, 84% undergraduates) completed an ecological momentary assessment (EMA) protocol and wore an alcohol monitor for five consecutive 24-h periods spanning 6 days (Wednesday-Monday). Each morning, participants reported their drinking intentions for the day and their previous day's alcohol consumption and the number of negative drinking consequences. Multilevel models showed that, at the within-person level, on days when people reported intending to drink, to get drunk, or to drink more than usual, they had higher odds of drinking, consumed more drinks, and had higher peak transdermal alcohol concentrations later that day. However, drinking occurred on 28% of days without drinking intentions, suggesting intentions were an imperfect signal for future drinking behavior. Morning drinking intentions also predicted experiencing more negative consequences, even after controlling for alcohol consumption. On average, young adults' morning-reported drinking-related intentions predicted increased odds of same-day drinking behavior and alcohol-related consequences. However, drinking frequently occurred on days participants did not intend to drink, suggesting that focusing only on drinking intention days will result in many missed prevention opportunities. Together, these results suggest the need for additional research to increase the predictive value of drinking intention assessments and for prevention interventions aimed at helping individuals follow through on their intentions not to drink.
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Affiliation(s)
- Jimikaye B Courtney
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael A Russell
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA, 16802, USA.
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19
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Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study. BMC Pregnancy Childbirth 2023; 23:19. [PMID: 36627569 PMCID: PMC9830616 DOI: 10.1186/s12884-022-05320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tobacco smoking and alcohol consumption before and during pregnancy increase the risk of adverse health outcomes for mother and child. Interventions to address smoking and drinking before and during pregnancy have the potential to reduce early-life health inequalities. In the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pilot study we aimed to evaluate the acceptability, feasibility and effectiveness of a complex intervention supporting women in smoking and alcohol cessation before and during pregnancy. METHODS From February 2019 till March 2021, we piloted the SAFER pregnancy intervention among pregnant women and women planning pregnancy in South-West Netherlands in an uncontrolled before-after study. Participants were supported in smoking and alcohol cessation via up to six group sessions and an online platform. In addition, biochemically validated cessation was rewarded with incentives (i.e. shopping vouchers) amounting up to 185 euros. We aimed to include 66 women. The primary outcome was smoking and/or alcohol cessation at 34-38 weeks of gestation (if pregnant) or after six group sessions (if not pregnant). Quantitative data were analysed using descriptive statistics. Focus group interviews among those involved in the study were conducted at the end of the study to explore their experiences. Qualitative data was analysed using thematic analysis. RESULTS Thirty-nine women who smoked were included; no women who consumed alcohol were referred to the study. Unemployment (51%), financial problems (36%) and a smoking partner (72%) were common. Thirteen women (33%) dropped out, often due to other problems impeding smoking cessation or 'being too busy' to participate in the group sessions. Eleven women (28%) had quit smoking at the study's endpoint. The personal and positive approach was highly valued and biochemical validation was felt to be helpful. CONCLUSION The SAFER pregnancy intervention seems appropriate for women in need of extra support for smoking cessation before and during pregnancy. Its impact on alcohol cessation could not be studied due to recruitment issues. Recruitment and prevention of early dropout need attention in further development of this intervention. TRIAL REGISTRATION Netherlands Trial Register: NL7493. Date registered: 04/02/2019.
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20
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Kushniruk A, Deluca P, Hemrage S, Drummond C. Acceptability and Feasibility of Wearable Transdermal Alcohol Sensors: Systematic Review. JMIR Hum Factors 2022; 9:e40210. [PMID: 36563030 PMCID: PMC9823584 DOI: 10.2196/40210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Transdermal alcohol sensors (TASs) have the potential to be used to monitor alcohol consumption objectively and continuously. These devices can provide real-time feedback to the user, researcher, or health professional and measure alcohol consumption and peaks of use, thereby addressing some of the limitations of the current methods, including breathalyzers and self-reports. OBJECTIVE This systematic review aims to evaluate the acceptability and feasibility of the currently available TAS devices. METHODS A systematic search was conducted in CINAHL, EMBASE, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases in February 2021. Two members of our study team independently screened studies for inclusion, extracted data, and assessed the risk of bias. The study's methodological quality was appraised using the Mixed Methods Appraisal Tool. The primary outcome was TAS acceptability. The secondary outcome was feasibility. The data are presented as a narrative synthesis. RESULTS We identified and analyzed 22 studies. Study designs included laboratory- and ambulatory-based studies, mixed designs, randomized controlled trials, and focus groups, and the length the device was worn ranged from days to weeks. Although views on TASs were generally positive with high compliance, some factors were indicated as potential barriers and there are suggestions to overcome these. CONCLUSIONS There is a lack of research investigating the acceptability and feasibility of TAS devices as a tool to monitor alcohol consumption in clinical and nonclinical populations. Although preliminary evidence suggests their potential in short-term laboratory-based studies with volunteers, more research is needed to establish long-term daily use with other populations, specifically, in the clinical and the criminal justice system. TRIAL REGISTRATION PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027.
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Affiliation(s)
- Andre Kushniruk
- Department of AddictionsInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Paolo Deluca
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sofia Hemrage
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Colin Drummond
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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21
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Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am 2022; 45:515-528. [PMID: 36055736 PMCID: PMC9352538 DOI: 10.1016/j.psc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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22
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Ash GI, Gueorguieva R, Barnett NP, Wang W, Robledo DS, DeMartini KS, Pittman B, Redeker NS, O’Malley SS, Fucito LM. Sensitivity, specificity, and tolerability of the BACTrack Skyn compared to other alcohol monitoring approaches among young adults in a field-based setting. Alcohol Clin Exp Res 2022; 46:783-796. [PMID: 35567595 PMCID: PMC9179100 DOI: 10.1111/acer.14804] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/14/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a need for novel alcohol biosensors that are accurate, able to detect alcohol concentration close in time to consumption, and feasible and acceptable for many clinical and research applications. We evaluated the field accuracy and tolerability of novel (BACTrack Skyn) and established (Alcohol Monitoring Systems SCRAM CAM) alcohol biosensors. METHODS The sensor and diary data were collected in a larger study of a biofeedback intervention and compared observationally in the present sub-study. Participants (high-risk drinkers, 40% female; median age 21) wore both Skyn and SCRAM CAM sensors for 1-6 days and were instructed to drink as usual. Data from the first cohort of participants (N = 27; 101 person-days) were used to find threshold values of transdermal alcohol that classified each day as meeting or not meeting defined levels of drinking (heavy, above-moderate, any). These values were used to develop scoring metrics that were subsequently tested using the second cohort (N = 20; 57 person-days). Data from both biosensors were compared to mobile diary self-report to evaluate sensitivity and specificity in relation to a priori standards established in the literature. RESULTS Skyn classification rules for Cohort #1 within 3 months of device shipment showed excellent sensitivity for heavy drinking (94%) and exceeded expectations for above-moderate and any drinking (78% and 69%, respectively), while specificity met expectations (91%). However, classification worsened when Cohort #1 devices ≥3 months from shipment were tested (area under curve for receiver operator characteristic 0.87 vs. 0.79) and the derived classification threshold when applied to Cohort #2 was inadequately specific (70%). Skyn tolerability metrics were excellent and exceeded the SCRAM CAM (p ≤ 0.001). CONCLUSIONS Skyn tolerability was favorable and accuracy rules were internally derivable but did not yield useful scoring metrics going forward across device lots and months of usage.
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Affiliation(s)
- Garrett I. Ash
- Yale School of Medicine; 333 Cedar Street; New Haven, CT 06510; USA,Veterans Affairs Connecticut Healthcare System; 950 Campbell Avenue; West Haven, CT 06516; USA
| | | | - Nancy P Barnett
- Brown School of Public Health; 121 South Main Street; Providence, RI 02903; USA
| | - Wuyi Wang
- Yale School of Medicine; 333 Cedar Street; New Haven, CT 06510; USA
| | - David S. Robledo
- Yale School of Medicine; 333 Cedar Street; New Haven, CT 06510; USA
| | | | - Brian Pittman
- Yale School of Medicine; 333 Cedar Street; New Haven, CT 06510; USA
| | - Nancy S Redeker
- Yale School of Medicine; 333 Cedar Street; New Haven, CT 06510; USA,Yale School of Nursing; 400 West Campus Drive; Orange, CT 06477; USA
| | | | - Lisa M. Fucito
- Yale School of Medicine; 333 Cedar Street; New Haven, CT 06510; USA,Yale Cancer Center, 333 Cedar Street; New Haven, CT 06520; USA,Smilow Cancer Hospital, Yale-New Haven Hospital; 35 Park Street; New Haven, CT 06511; USA
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23
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Clapp JD, Madden DR, Pakdaman S. Drinking with Friends: Measuring the Two-week Ecology of Drinking Behaviors. Am J Health Behav 2022; 46:96-113. [PMID: 35501964 DOI: 10.5993/ajhb.46.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Despite the substantial influence these acute alcohol-related problems cause globally, past research has failed historically to capture the dynamic nature of drinking events, including how multiple factors (ie, individual, group, and environmental) interact to affect event-level intoxication. Fortunately, technology (eg, transdermal alcohol monitors) and smartphone surveys have provided researchers with new avenues to measure the complex nature of alcohol consumption. This paper presents the methods of a pilot study that sought to measure event-level alcohol consumption in a natural drinking group of college students. Methods: Ten groups of friends (N=49) were followed for 2 weeks with daily diary surveys, continuous activity trackers, hourly geographic ecological momentary assessments (EMAs) on 4 separate drinking occasions, and a transdermal alcohol monitor during one group-based social event. Results: On average, participants responded to > 75% of both daily diaries and EMAs and were compliant with activity trackers on 96% of monitoring days. Over 90% of the sample had usable transdermal data and after smoothing, peak transdermal alcohol contents ranged from 0.13 to 0.395 during the observation evening. Conclusion: The lessons learned during this pilot study can provide a building block for future work in this area, especially as data collection in alcohol research rapidly advances.
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Affiliation(s)
- John D. Clapp
- John D. Clapp, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States; College of Social Work, The Ohio State University, Columbus, OH, United States; Keck School of Medicine,
Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Danielle R. Madden
- Danielle R. Madden, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States; College of Social Work, The Ohio State University, Columbus, OH, United States; Institute for
Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Sheila Pakdaman
- Sheila Pakdaman, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States;,
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24
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Brobbin E, Deluca P, Hemrage S, Drummond C. Accuracy of Wearable Transdermal Alcohol Sensors: Systematic Review. J Med Internet Res 2022; 24:e35178. [PMID: 35436239 PMCID: PMC9052024 DOI: 10.2196/35178] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There are a range of wearable transdermal alcohol sensors that are available and are being developed. These devices have the potential to monitor alcohol consumption continuously over extended periods in an objective manner, overcoming some of the limitations of other alcohol measurement methods (blood, breath, and urine). OBJECTIVE The objective of our systematic review was to assess wearable transdermal alcohol sensor accuracy. METHODS A systematic search of the CINAHL, Embase, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases was conducted in February 2021. In total, 2 team members (EB and SH) independently screened studies for inclusion, extracted data, and assessed the risk of bias. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. The primary outcome was transdermal alcohol sensor accuracy. The data were presented as a narrative synthesis. RESULTS We identified and analyzed 32 studies. Study designs included laboratory, ambulatory, and mixed designs, as well as randomized controlled trials; the length of time for which the device was worn ranged from days to weeks; and the analyzed sample sizes ranged from 1 to 250. The results for transdermal alcohol concentration data from various transdermal alcohol sensors were generally found to positively correlate with breath alcohol concentration, blood alcohol concentration, and self-report (moderate to large correlations). However, there were some discrepancies between study reports; for example, WrisTAS sensitivity ranged from 24% to 85.6%, and specificity ranged from 67.5% to 92.94%. Higher malfunctions were reported with the BACtrack prototype (16%-38%) and WrisTAS (8%) than with SCRAM (2%); however, the former devices also reported a reduced time lag for peak transdermal alcohol concentration values when compared with SCRAM. It was also found that many companies were developing new models of wearable transdermal alcohol sensors. CONCLUSIONS As shown, there is a lack of consistency in the studies on wearable transdermal alcohol sensor accuracy regarding study procedures and analyses of findings, thus making it difficult to draw direct comparisons between them. This needs to be considered in future research, and there needs to be an increase in studies directly comparing different transdermal alcohol sensors. There is also a lack of research investigating the accuracy of transdermal alcohol sensors as a tool for monitoring alcohol consumption in clinical populations and use over extended periods. Although there is some preliminary evidence suggesting the accuracy of these devices, this needs to be further investigated in clinical populations. TRIAL REGISTRATION PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027.
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Affiliation(s)
- Eileen Brobbin
- Department of Addictions, King's College London, London, United Kingdom
| | - Paolo Deluca
- Department of Addictions, King's College London, London, United Kingdom
| | - Sofia Hemrage
- Department of Addictions, King's College London, London, United Kingdom
| | - Colin Drummond
- Department of Addictions, King's College London, London, United Kingdom
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25
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Fridberg DJ, Wang Y, Porges E. Examining features of transdermal alcohol biosensor readings: A promising approach with implications for research and intervention. Alcohol Clin Exp Res 2022; 46:514-516. [PMID: 35187662 PMCID: PMC9018548 DOI: 10.1111/acer.14794] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel J. Fridberg
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA 60637
| | - Yan Wang
- Department of Epidemiology, The University of Florida, Gainesville, Florida, 32610, USA
| | - Eric Porges
- Center for Cognitive Aging and Memory, McKnight Brain Foundation, University of Florida, Gainesville, Florida; Department of Clinical & Health Psychology, College of Health Professions, University of Florida, Gainesville, Florida, 32610, USA
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26
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Moore S, Radunskaya A, Zollinger E, Grant KA, Gonzales S, Walter NAR, Baker EJ. Pairing food and drink: A physiological model of blood ethanol levels for a variety of drinking behaviors. Math Biosci 2022; 345:108778. [PMID: 35033503 PMCID: PMC8918017 DOI: 10.1016/j.mbs.2022.108778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022]
Abstract
We present a blood ethanol concentration compartment model which utilizes an animal's ethanol intake, food intake, and weight to predict the animal's blood ethanol concentration at any given time. By incorporating the food digestion process into the model we can predict blood ethanol concentration levels over time for a variety of drinking and eating scenarios. The model is calibrated and validated using data from cohorts of male monkeys, and is able to capture blood ethanol concentration kinetics of the monkeys from a variety of drinking behavior classifications.
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Affiliation(s)
- Sharon Moore
- Baylor University, Department of Computer Science, Bioinformatics, Waco, TX, USA
| | - Ami Radunskaya
- Pomona College, Department of Mathematics and Statistics, Claremont, CA, USA
| | | | | | | | | | - Erich J Baker
- Baylor University, Department of Computer Science, Bioinformatics, Waco, TX, USA
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27
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García FIS, Indic P, Stapp J, Chintha KK, He Z, Brooks JH, Carreiro S, Derefinko KJ. Using wearable technology to detect prescription opioid self-administration. Pain 2022; 163:e357-e367. [PMID: 34270522 PMCID: PMC10348884 DOI: 10.1097/j.pain.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 06/11/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Appropriate monitoring of opioid use in patients with pain conditions is paramount, yet it remains a very challenging task. The current work examined the use of a wearable sensor to detect self-administration of opioids after dental surgery using machine learning. Participants were recruited from an oral and maxillofacial surgery clinic. Participants were 46 adult patients (26 female) receiving opioids after dental surgery. Participants wore Empatica E4 sensors during the period they self-administered opioids. The E4 collected physiological parameters including accelerometer x-, y-, and z-axes, heart rate, and electrodermal activity. Four machine learning models provided validation accuracies greater than 80%, but the bagged-tree model provided the highest combination of validation accuracy (83.7%) and area under the receiver operating characteristic curve (0.92). The trained model had a validation sensitivity of 82%, a specificity of 85%, a positive predictive value of 85%, and a negative predictive value of 83%. A subsequent test of the trained model on withheld data had a sensitivity of 81%, a specificity of 88%, a positive predictive value of 87%, and a negative predictive value of 82%. Results from training and testing model of machine learning indicated that opioid self-administration could be identified with reasonable accuracy, leading to considerable possibilities of the use of wearable technology to advance prevention and treatment.
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Affiliation(s)
| | | | | | | | - Zhaomin He
- Department of Nursing, The University of Texas at Tyler, Tyler, TX, United States
| | - Jeffrey H. Brooks
- Department of Oral and Maxillofacial Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Stephanie Carreiro
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Karen J. Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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28
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Silva KDS, Sampaio AAS, Miguel ADQC. Contingency Management applied to Alcohol Use Disorder: Systematic Review. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38215.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This systematic review evaluated the efficacy of applying Contingency Management (CM) to Alcohol Use Disorder. We followed the PRISMA recommendation and consulted the following databases: Cochrane Library, MEDLINE Complete, PsycINFO and Pubmed. A total of eight randomized controlled trials were included in this review, all of them with good methodological quality. In seven of these, CM was more efficacious in promoting continuous abstinence. Both trials that evaluated treatment retention found statistically significant results favorable to CM. On two of the three trials presenting follow-up results, CM was more efficacious in promoting abstinence. The large-scale application of CM can promote substantial public health improvements and should be encouraged.
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29
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Silva KDS, Sampaio AAS, Miguel ADQC. Manejo de Contingência Aplicado ao Transtorno por Uso de Álcool: Revisão Sistemática. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38215.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Esta revisão sistemática avaliou a eficácia do Manejo de Contingência (MC) no tratamento do Transtorno por Uso de Álcool. Para isso, foi utilizada a recomendação PRISMA e consultadas as bases de dados: Cochrane Library, MEDLINE Complete, PsycINFO e Pubmed. Foram incluídos oito ensaios clínicos randomizados nesta revisão. Em sete, o MC foi mais eficaz em promover abstinência continuada. Dos dois que avaliaram a retenção no tratamento, ambos encontraram resultados estatisticamente favoráveis ao MC. Dos três que apresentaram resultados de avaliação de seguimento, em dois o MC foi mais eficaz em promover abstinência. Todos apresentaram boa qualidade metodológica. A aplicação do MC em larga escala pode promover melhorias substanciais para a saúde pública e deve ser encorajada.
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30
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Naudé GP, Johnson MW, Strickland JC, Berry MS, Reed DD. At-Risk Drinking, Operant Demand, and Cross-Commodity Discounting as Predictors of Drunk Driving in Underage College Women. Behav Processes 2021; 195:104548. [PMID: 34801655 DOI: 10.1016/j.beproc.2021.104548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
Behavioral economics offers unique tools for assessing value and motivation associated with college drinking. Tasks that model changes in consumption as a function of price (operant demand) or the decline in an outcome's subjective value as a function of time-to-occurrence (delay discounting) provide valuable information that may efficiently supplement clinical screening instruments when characterizing alcohol use severity. The first aim of this investigation was to examine the extent to which at-risk drinking, operant demand for alcohol, and single- and cross-commodity discounting of money and alcohol predict adverse consequences of past-month drinking in underage college women (N = 72). The second aim was to determine whether these clinical and behavioral economic measures could significantly predict the odds of past-month drunk driving, a serious public health concern due to the increasing prevalence of heavy episodic drinking among women in their first 1 - 2 years of college. Results showed that higher scores on the consumption factor of the Alcohol Use Disorder Identification Test (AUDIT-C), greater Persistence (consumption amidst constraint) and Amplitude (maximum consumption) of demand, as well as lower rates of discounting for choices between receiving alcohol now or double the amount after a delay (choosing the larger amount of alcohol even when it is delayed) significantly predicted adverse consequences of past-month drinking. Moreover, scores on the AUDIT-C, Amplitude of demand, and higher rates of discounting for choices between receiving alcohol now and money later (choosing immediately available alcohol at the expense of double the equivalent in delayed money) significantly predicted past-month drunk driving. We contend that operant demand along with single- and cross-commodity discounting can be viewed as intersecting measures of reinforcer value with clinical relevance to college women.
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Affiliation(s)
- Gideon P Naudé
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA; Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA.
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith S Berry
- Department of Health Education and Behavior, University of Florida; Department of Psychology, University of Florida
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA; Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
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GUNN RACHELL, STEINGRIMSSON JONA, MERRILL JENNIFERE, SOUZA TIMOTHY, BARNETT NANCY. Characterising patterns of alcohol use among heavy drinkers: A cluster analysis utilising alcohol biosensor data. Drug Alcohol Rev 2021; 40:1155-1164. [PMID: 33987927 PMCID: PMC9972297 DOI: 10.1111/dar.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Previous research has predominately relied on person-level or single characteristics of drinking episodes to characterise patterns of drinking that may confer risk. This research often relies on self-report measures. Advancements in wearable alcohol biosensors provide a multi-faceted objective measure of drinking. The current study aimed to characterise drinking episodes using data derived from a wearable alcohol biosensor. METHODS Participants (n = 45) were adult heavy drinkers who wore the Secure Continuous Remote Alcohol Monitoring (SCRAM) bracelet and reported on their drinking behaviours. Cluster analysis was used to evaluate unique combinations of alcohol episode characteristics. Associations between clusters and self-reported person and event-level factors were also examined in univariable and multivariable models. RESULTS Results suggested three unique clusters: Cluster 1 (most common, slowest rate of rise to and decline from peak), Cluster 2 (highest peak transdermal alcohol concentration and area under the curve) and Cluster 3 (fastest rate of decline from peak). Univariable analyses distinguished Cluster 1 as having fewer self-reported drinks and fewer episodes that occurred on weekends relative to Cluster 2. The effect for number of drinks remained in multivariable analyses. DISCUSSION AND CONCLUSIONS This is the first study to characterise drinking patterns at the event-level using objective data. Results suggest that it is possible to distinguish drinking episodes based on several characteristics derived from wearable alcohol biosensors. This examination lays the groundwork for future studies to characterise patterns of drinking and their association with consequences of drinking behaviour.
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Affiliation(s)
- RACHEL L. GUNN
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - JON A. STEINGRIMSSON
- Biostatistics, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - JENNIFER E. MERRILL
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - TIMOTHY SOUZA
- Data Management Systems, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - NANCY BARNETT
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
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Fell JC, Scolese J. The effectiveness of alcohol monitoring as a treatment for driving-while-intoxicated (DWI) offenders: A literature review and synthesis. TRAFFIC INJURY PREVENTION 2021; 22:S1-S7. [PMID: 34672885 DOI: 10.1080/15389588.2021.1980783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/01/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The advent of continuous, passive, transdermal alcohol-monitoring devices and portable breath-testing devices with cameras provides a more efficient and reliable method for controlling the impaired driving of driving-under-the-influence (DUI) offenders. The objective of this study was to conduct a comprehensive literature review and synthesis of the strategies, the obstacles and the effectiveness of implementing alcohol monitoring as a component of treatment for DUI offenders. METHOD A formalized review of the existing literature was conducted including both peer-reviewed and gray literature resources. Professional association websites were also searched in an effort to seek information on the effectiveness or ineffectiveness of alcohol monitoring as a strategy to treat DUI offenders. The review was guided by pre-defined inclusion/exclusion criteria that identified the scope and key terms to use when searching. RESULTS The literature shows that there is promising to strong evidence that alcohol monitoring is an effective component in treating DUI offenders and reducing recidivism rates. Alcohol ignition interlocks had the most studies (71 of the 131 articles identified in this review) and research shows that recidivism rates can be reduced by 50 to 90 percent for offenders while the interlock is installed. However, most ignition interlock studies are subject to sampling issues where participants are not randomly assigned to experimental and comparison groups. There is also evidence that alcohol monitoring is a key measure in 24/7 Sobriety Programs, in enforcing abstinence, and in overall alcohol treatment programs. CONCLUSIONS Transdermal monitoring is generally effective in deterring offenders from drinking alcohol. Offenders who drink or are otherwise noncompliant are likely to be identified. Transdermal monitoring helps enforce abstinence, which in turn helps offenders quit drinking and go into a recovery stage, potentially creating long-term safety benefits for the community. Continuous transdermal monitoring is a more effective means of monitoring drinking than other techniques and technologies (e.g., self-report, periodic or random breath tests, patches, or urinalysis).
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Affiliation(s)
- James C Fell
- NORC at the University of Chicago, Bethesda, Maryland
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Richards VL, Liu Y, Orr J, Leeman RF, Barnett NP, Bryant K, Cook RL, Wang Y. Sociodemographic and clinical factors associated with transdermal alcohol concentration from the SCRAM biosensor among persons living with and without HIV. Alcohol Clin Exp Res 2021; 45:1804-1811. [PMID: 34342009 DOI: 10.1111/acer.14665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transdermal alcohol biosensors can objectively monitor alcohol use by measuring transdermal alcohol concentration (TAC). However, it is unclear how sociodemographic and clinical factors that influence alcohol metabolism are associated with TAC. The main aim of this study was to examine how sociodemographic factors (sex, age, race/ethnicity) and clinical factors (body mass index, liver enzymes: alanine aminotransferase [ALT] and aspartate transaminase [AST]), alcohol use disorder, and HIV status were associated with TAC while controlling for level of alcohol use. METHODS We analyzed data from a prospective study involving contingency management for alcohol cessation among persons living with and without human immunodeficiency virus (HIV) that used the Secure Continuous Remote Alcohol Monitoring (SCRAM) biosensor. Forty-three participants (Mage = 56.6 years; 63% male; 58% people living with HIV) yielded 183 SCRAM-detected drinking days. Two indices derived from SCRAM: peak TAC (reflecting level of intoxication) and TAC area under the curve (TAC-AUC; reflecting alcohol volume)-were the main outcomes. Self-reported alcohol use (drinks/drinking day) measured by Timeline Followback was the main predictor. To examine whether factors of interest were associated with TAC, we used individual generalized estimating equations (GEE), followed by a multivariate GEE model to include all significant predictors to examine their associations with TAC beyond the effect of self-reported alcohol use. RESULTS Number of drinks per drinking day (B = 0.29, p < 0.01) and elevated AST (B = 0.50, p = 0.01) were significant predictors of peak TAC. Positive HIV status, female sex, elevated AST, and number of drinks per drinking day were positively associated with TAC-AUC at the bivariate level, whereas only self-reported alcohol use (B = 0.85, p < 0.0001) and female sex (B = 0.67, p < 0.05) were significant predictors of TAC-AUC at the multivariate level. CONCLUSIONS HIV status was not independently associated with TAC. Future studies should consider the sex and liver function of the participant when using alcohol biosensors to measure alcohol use.
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Affiliation(s)
- Veronica L Richards
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yiyang Liu
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Jessica Orr
- Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Nancy P Barnett
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
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Miguel A, Smith C, Perea N, Johnson K, McDonell M, McPherson S. Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study. JMIR Form Res 2021; 5:e25796. [PMID: 34279238 PMCID: PMC8329757 DOI: 10.2196/25796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/12/2021] [Accepted: 05/31/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. OBJECTIVE In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. METHODS Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians' acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians' assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients' usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. RESULTS Recruitment for this study began in January 2021 and is expected to be completed by December 2021. CONCLUSIONS This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas.
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Affiliation(s)
- Andre Miguel
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Crystal Smith
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Nicole Perea
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, United States
| | - Kim Johnson
- Managed Health Connections, Spokane, WA, United States
| | - Michael McDonell
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S Floyd College of Medicine, Washington State University, Spokane, WA, United States
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van Egmond K, Wright CJC, Livingston M, Kuntsche E. A parallel test of the SCRAM-CAM transdermal monitors ensuring reliability. Drug Alcohol Rev 2021; 40:1122-1130. [PMID: 34235793 DOI: 10.1111/dar.13353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Previous studies validating the transdermal alcohol concentration (TAC) as measured by the Secure Continuous Remote Alcohol Monitors Continuous Alcohol Monitoring (SCRAM-CAM) have tested the monitor against self-reports or breath alcohol concentration (BrAC). This study aims to provide further evidence of the reliability of the SCRAM-CAM testing two monitors in parallel. METHODS Participants (N = 21) received four standard drinks in a laboratory session while wearing SCRAM-CAMs simultaneously on their left and right ankles. The SCRAM-CAMs sampled TAC every 30 min and participants were monitored for at least 2-3 h after their BrAC levels reached zero. Weight and height measures were taken to calculate body mass index (BMI). RESULTS There was a positive correlation between the TAC measurements from the left and right SCRAM-CAM (r = 0.718), a cross-correlation model revealed that this correlation was not significantly different for sex or BMI. Area under the TAC curve (AUC) and peak TAC values as measured by the left and right SCRAM-CAM also show positive correlations (r = 0.554 and r = 0.579, respectively). Cross-correlation models show a significant effect of BMI on the relationship between left and right peak TAC values, which may be due to outlier effects. No further effects were significant for on both peak and AUC values. DISCUSSION AND CONCLUSIONS Results show that TAC measured by SCRAM-CAMs worn on the left and right showed a good correlation, with correlations between AUC and peak TAC values considered to be fair. TAC monitors show promise for use in research settings; however, work is needed testing the reliability of TAC as measured by two TAC monitors.
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Affiliation(s)
- Kelly van Egmond
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia
| | - Cassandra J C Wright
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Livingston
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Pilot Study of an Integrated Smartphone and Breathalyzer Contingency Management Intervention for Alcohol Use. J Addict Med 2021; 14:193-198. [PMID: 31567597 DOI: 10.1097/adm.0000000000000553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Monitoring devices provide a platform for assessing alcohol use and implementing alcohol interventions. This pilot study focused on assessing the early-stage feasibility and usability of a smartphone-based application and breathalyzer used in a contingency management intervention for alcohol use. METHODS Six nontreatment-seeking participants completed a 9-week ABA within-subjects designed intervention targeting alcohol use. Participants submitted 2 to 8 alcohol breathalyzer samples per day and completed self-report drinking measures and usability assessments. During the A phases (weeks 1-3 and 8-9), participants received reinforces for submitting breathalyzer samples, regardless of their results. During the contingency management, B phase (weeks 4-7), and received reinforcers only when negative breathalyzer samples were submitted. Usability assessment of the application was also conducted during weeks 2 and 9. RESULTS Participants in the contingent B phase (49%) were more likely to submit alcohol-negative breathalyzer samples compared with the noncontingent A phases (27%; P < 0.001). Usability assessment of the application varied, and participants noted several technical concerns. CONCLUSION The use of smartphones and breathalyzers may be a practical solution to extend the reach of contingency management during and after treatment.
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Jiang N, Davies S, Jiao Y, Blyth J, Butt H, Montelongo Y, Yetisen AK. Doubly Photopolymerized Holographic Sensors. ACS Sens 2021; 6:915-924. [PMID: 33557517 DOI: 10.1021/acssensors.0c02109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Holographic sensors are two-dimensional (2D) photonic crystals that diffract narrow-band light in the visible spectrum to quantify analytes in aqueous solutions. Here, a holographic fabrication setup was developed to produce holographic sensors through a doubly polymerization system of a poly-2-hydroxyethyl methacrylate hydrogel film using a pulsed Nd:YAG laser (λ = 355 nm, 5 ns, 100 mJ). Wavelength shifts of holographic Bragg peak in response to alcohol species (0-100 vol %) were characterized. Diffraction spectra showed that the holographic sensors could be used for short-chain alcohols at concentrations up to 60 vol %. The reversibility of the sensor was demonstrated, exhibiting a response time of 7.5 min for signal saturation. After 30 cycles, the Bragg peak and color remained the same in both 20 and 60 vol %. The fabrication parameters were simulated in MATLAB using a 2D finite-difference time-domain algorithm to model the interference pattern and energy flux profile of laser beam recording in the hydrogel medium. This work demonstrates a particle-free holographic sensor that offers continuous, reversible, and rapid colorimetric readouts for the real-time quantification of alcohols.
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Affiliation(s)
- Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Sam Davies
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Yimeng Jiao
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Jeff Blyth
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Haider Butt
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi 127788, UAE
| | - Yunuen Montelongo
- Centro de Investigaciones en Óptica, A.C., Colonia Lomas del campestre, PC, León 37150, Mexico
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, U.K
| | - Ali K. Yetisen
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, U.K
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Mun EY, Li X, Businelle MS, Hébert ET, Tan Z, Barnett NP, Walters ST. Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness. Alcohol Clin Exp Res 2021; 45:864-876. [PMID: 33583057 PMCID: PMC8252787 DOI: 10.1111/acer.14571] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Background Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self‐reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self‐reports via the Timeline Follow‐Back (TLFB) among adults experiencing homelessness. Methods Forty‐nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants. Results EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level. Conclusions This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.
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Affiliation(s)
- Eun-Young Mun
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Xiaoyin Li
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Michael S Businelle
- Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA.,Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily T Hébert
- UTHealth School of Public Health in Austin, Austin, OK, USA
| | - Zhengqi Tan
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, RI, USA
| | - Scott T Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
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Davis-Martin RE, Alessi SM, Boudreaux ED. Alcohol Use Disorder in the Age of Technology: A Review of Wearable Biosensors in Alcohol Use Disorder Treatment. Front Psychiatry 2021; 12:642813. [PMID: 33828497 PMCID: PMC8019775 DOI: 10.3389/fpsyt.2021.642813] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/12/2021] [Indexed: 02/05/2023] Open
Abstract
Biosensors enable observation and understanding of latent physiological occurrences otherwise unknown or invasively detected. Wearable biosensors monitoring physiological constructs across a wide variety of mental and physical health conditions have become an important trend in innovative research methodologies. Within substance use research, explorations of biosensor technology commonly focus on identifying physiological indicators of intoxication to increase understanding of addiction etiology and to inform treatment recommendations. In this review, we examine the state of research in this area as it pertains to treatment of alcohol use disorders specifically highlighting the gaps in our current knowledge with recommendations for future research. Annually, alcohol use disorders affect approximately 15 million individuals. A primary focus of existing wearable technology-based research among people with alcohol use disorders is identifying alcohol intoxication. A large benefit of wearable biosensors for this purpose is they provide continuous readings in a passive manner compared with the gold standard measure of blood alcohol content (BAC) traditionally measured intermittently by breathalyzer or blood draw. There are two primary means of measuring intoxication with biosensors: gait and sweat. Gait changes have been measured via smart sensors placed on the wrist, in the shoe, and mobile device sensors in smart phones. Sweat measured by transdermal biosensors detects the presence of alcohol in the blood stream correlating to BAC. Transdermal biosensors have been designed in tattoos/skin patches, shirts, and most commonly, devices worn on the ankle or wrist. Transdermal devices were initially developed to help monitor court-ordered sobriety among offenders with alcohol use disorder. These devices now prove most useful in continuously tracking consumption throughout clinical trials for behavioral treatment modalities. More recent research has started exploring the uses for physical activity trackers and physiological arousal sensors to guide behavioral interventions for relapse prevention. While research has begun to demonstrate wearable devices' utility in reducing alcohol consumption among individuals aiming to cutdown on their drinking, monitoring sustained abstinence in studies exploring contingency management for alcohol use disorders, and facilitating engagement in activity-based treatment interventions, their full potential to further aid in understanding of, and treatment for, alcohol use disorders has yet to be explored.
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Affiliation(s)
- Rachel E Davis-Martin
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sheila M Alessi
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Bischof G, Lange N, Rumpf HJ, Preuss UW. Reduced drinking and harm reduction in the treatment of alcohol use disorders. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-10-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time.
Design/methodology/approach
A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented.
Findings
Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce.
Originality/value
Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.
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McDonnell A, MacNeill C, Chapman B, Gilbertson N, Reinhardt M, Carreiro S. Leveraging digital tools to support recovery from substance use disorder during the COVID-19 pandemic response. J Subst Abuse Treat 2020; 124:108226. [PMID: 33303253 DOI: 10.1016/j.jsat.2020.108226] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
Treatment for substance use disorder (SUD) during the COVID-19 pandemic poses unique challenges, both due to direct effects from the illness, and indirect effects from the physical measures needed to "flatten the curve." Stress, isolation, lack of structure, limited access to physical and mental health care, and changes in treatment paradigms all increase risk of return to drug use events and pose barriers to recovery for people with SUDs. The pandemic has forced treatment providers and facilities to rapidly adapt to address these threats while redesigning their structure to accommodate physical distancing regulations. Digital health interventions can function without the need for physical proximity. Clinicians can use digital health intervention, such as telehealth, wearables, mobile applications, and other remote monitoring devices, to convert in-person care to remote-based care, and they can leverage these tools to address some of the pandemic-specific challenges to treatment. The current pandemic provides the opportunity to rapidly explore the advantages and limitations of these technologies in the care of individuals with SUD.
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Affiliation(s)
- Amy McDonnell
- Aware Recovery Care, Wallingford, CT 06492, United States of America
| | - Courtney MacNeill
- Aware Recovery Care, Wallingford, CT 06492, United States of America
| | - Brittany Chapman
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA 01655, United States of America
| | | | | | - Stephanie Carreiro
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA 01655, United States of America.
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Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study: a before-after study protocol. NPJ Prim Care Respir Med 2020; 30:51. [PMID: 33208752 PMCID: PMC7674488 DOI: 10.1038/s41533-020-00209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
Despite existing interventions, tobacco smoking and alcohol consumption during pregnancy are common. The Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy intervention combines monthly group sessions, access to a web-based platform and incentives upon biochemically validated cessation for a maximum duration of 6 months to promote cessation of smoking and alcohol use before and during pregnancy. To inform development of the SAFER pregnancy intervention, two focus groups with the target population were held beforehand, with results reported here alongside the final SAFER pregnancy study protocol. In a before−after study we aim to include 66 women who are pregnant or have a wish to become pregnant and who smoke and/or consume alcohol (i.e. target population of the SAFER pregnancy intervention). The primary outcome measure is cessation of smoking and/or alcohol use at 34−38 weeks of gestation, or after six group sessions if women did not become pregnant during the study period. Secondary outcomes focus on the barriers and facilitators for implementation of the SAFER pregnancy intervention.
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Carreiro S, Newcomb M, Leach R, Ostrowski S, Boudreaux ED, Amante D. Current reporting of usability and impact of mHealth interventions for substance use disorder: A systematic review. Drug Alcohol Depend 2020; 215:108201. [PMID: 32777691 PMCID: PMC7502517 DOI: 10.1016/j.drugalcdep.2020.108201] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Connected interventions use data collected through mobile/wearable devices to trigger real-time interventions and have great potential to improve treatment for substance use disorder (SUD). This review aims to describe the current landscape, effectiveness and usability of connected interventions for SUD. METHODS A systematic review was conducted to identify articles evaluating connected health interventions for SUD in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (PubMed, IEEE, and Scopus) were searched over a five-year period. Included articles described a connected health intervention targeting SUD and provided outcomes data. Data were extracted using a standardized reporting tool. RESULTS A total of 1676 unique articles were identified during the initial search, with 32 articles included in the final analysis. Seven articles of the 32 were derived from two large studies. The most commonly studied SUD was alcohol use disorder. Sixteen articles reported at least one statistically significant result with respect to reduced craving and/or substance use. The majority of articles used ecological momentary assessment to trigger interventions, while four used biologic/physiologic data. Two articles used a wearable device. Common intervention types included craving management, coping assistance, and tailored feedback. Twenty-three articles measured usability factors, and acceptability was generally reported as high. CONCLUSION Identified themes included a focus on AUD, use of smart phones, use of EMA for intervention delivery, positive effects on SUD related outcomes, and overall high acceptability. Wearables that directly monitor biologic data and predictive analytics using integrated data streams represent understudied opportunities for new research.
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Affiliation(s)
- Stephanie Carreiro
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Mark Newcomb
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Rebecca Leach
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Simon Ostrowski
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Daniel Amante
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Perlmutter A, Benchoufi M, Ravaud P, Tran VT. Identification of Patient Perceptions That Can Affect the Uptake of Interventions Using Biometric Monitoring Devices: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2020; 22:e18986. [PMID: 32915153 PMCID: PMC7519434 DOI: 10.2196/18986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Biometric monitoring devices (BMDs) are wearable or environmental trackers and devices with embedded sensors that
can remotely collect high-frequency objective data on patients’ physiological, biological, behavioral, and environmental
contexts (for example, fitness trackers with accelerometer). The real-world effectiveness of interventions using biometric monitoring devices depends on patients’ perceptions of these interventions. Objective We aimed to systematically review whether and how recent randomized controlled trials (RCTs) evaluating interventions using BMDs assessed patients’ perceptions toward the intervention. Methods We systematically searched PubMed (MEDLINE) from January 1, 2017, to December 31, 2018, for RCTs evaluating interventions using BMDs. Two independent investigators extracted the following information: (1) whether the RCT collected information on patient perceptions toward the intervention using BMDs and (2) if so, what precisely was collected, based on items from questionnaires used and/or themes and subthemes identified from qualitative assessments. The two investigators then synthesized their findings in a schema of patient perceptions of interventions using BMDs. Results A total of 58 RCTs including 10,071 participants were included in the review (the median number of randomized participants was 60, IQR 37-133). BMDs used in interventions were accelerometers/pedometers (n=35, 60%), electrochemical biosensors (eg, continuous glucose monitoring; n=18, 31%), or ecological momentary assessment devices (eg, carbon monoxide monitors for smoking cessation; n=5, 9%). Overall, 26 (45%) trials collected information on patient perceptions toward the intervention using BMDs and allowed the identification of 76 unique aspects of patient perceptions that could affect the uptake of these interventions (eg, relevance of the information provided, alarm burden, privacy and data handling, impact on health outcomes, independence, interference with daily life). Patient perceptions were unevenly collected in trials. For example, only 5% (n=3) of trials assessed how patients felt about privacy and data handling aspects of the intervention using BMDs. Conclusions Our review showed that less than half of RCTs evaluating interventions using BMDs assessed patients’ perceptions toward interventions using BMDs. Trials that did assess perceptions often only assessed a fraction of them. This limits the extrapolation of the results of these RCTs to the real world. We thus provide a comprehensive schema of aspects of patient perceptions that may affect the uptake of interventions using BMDs and which should be considered in future trials. Trial Registration PROSPERO CRD42018115522; https://tinyurl.com/y5h8fjgx
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Affiliation(s)
- Alexander Perlmutter
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,School of Global Public Health, New York University, New York, NY, United States
| | - Mehdi Benchoufi
- UMR1153 (METHODS team), Centre de Recherche en Epidemiologie et StatistiqueS, Institut national de la santé et de la recherche médicale, Paris, France
| | - Philippe Ravaud
- UMR1153 (METHODS team), Centre de Recherche en Epidemiologie et StatistiqueS, Institut national de la santé et de la recherche médicale, Paris, France
| | - Viet-Thi Tran
- UMR1153 (METHODS team), Centre de Recherche en Epidemiologie et StatistiqueS, Institut national de la santé et de la recherche médicale, Paris, France
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Goldfine C, Lai JT, Lucey E, Newcomb M, Carreiro S. Wearable and Wireless mHealth Technologies for Substance Use Disorder. CURRENT ADDICTION REPORTS 2020; 7:291-300. [PMID: 33738178 DOI: 10.1007/s40429-020-00318-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose of review The goal of this scoping review is to evaluate the advances in wearable and other wireless mobile health (mHealth) technologies in the treatment of substance use disorders. Recent findings There are a variety of wireless technologies under investigation for the treatment of substance use disorder. Wearable sensors are the most commonly used technology. They can be used to decrease heavy substance use, mitigate factors related to relapse, and monitor for overdose. New technologies pose distinct advantages over traditional therapies by increasing geographic availability and continuously providing feedback and monitoring while remaining relatively non-invasive. Summary Wearable and novel technologies are important to the evolving landscape of substance use treatment. As technologies continue to develop and show efficacy, they should be incorporated into multifactorial treatment plans.
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Affiliation(s)
- Charlotte Goldfine
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Jeffrey T Lai
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Evan Lucey
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Mark Newcomb
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Stephanie Carreiro
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
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Villalba K, Cook C, Dévieux JG, Ibanez GE, Oghogho E, Neira C, Cook RL. Facilitators and barriers to a contingency management alcohol intervention involving a transdermal alcohol sensor. Heliyon 2020; 6:e03612. [PMID: 32258468 PMCID: PMC7103775 DOI: 10.1016/j.heliyon.2020.e03612] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 11/03/2022] Open
Abstract
Research on contingency management is limited due to feasibility issues with monitoring adherence. Incentives usually depend on objective measures to verify compliance; therefore, biological markers for identifying alcohol use are not as dependable for the use of financial contingency studies. The Secure Continuous Remote Alcohol Monitor (SCRAM) is an objective alcohol biosensor that can be locked onto a person's ankle to address these limitations. In preparation for a large, contingency management study for HIV-positive and HIV-negative persons with heavy drinking, the aims for the study were to (1) explore barriers and facilitators to participating in a contingency management intervention using the SCRAM ankle monitor as the potential alcohol measure for the intervention; (2) explore levels of appropriate compensation for using the SCRAM and for study assessments as part of a contingency management intervention study; and (3) attitudes and beliefs on lifestyle changes as a consequence of wearing the SCRAM among HIV-positive and HIV-negative heavy drinkers in Florida. Five focus groups were conducted and we collected qualitative data from thirty-seven individuals (18 men; 19 women). During the analysis, six themes were identified as barriers and facilitators for participation in a contingency management intervention using the SCRAM sensor to measure alcohol use: (1) health assessment, (2) monetary incentives including payment structure and levels of compensation, (3) stigma associated with wearing the SCRAM sensor, (4) aesthetics and other related concerns with wearing the SCRAM sensor, (5) motivation to stop drinking, and (6) social support. Stigma was a major barrier for wearing the SCRAM sensor; however, if participants were motivated to change their behavior then the monetary incentives became a facilitator to wearing the sensor. In addition to the financial contingency method, social support may further increase the odds for participants to change their behaviors.
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Affiliation(s)
- Karina Villalba
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Gladys E Ibanez
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Etinosa Oghogho
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Camila Neira
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Luczak SE, Ramchandani VA. Special issue on alcohol biosensors: Development, use, and state of the field: Summary, conclusions, and future directions. Alcohol 2019; 81:161-165. [PMID: 31299292 DOI: 10.1016/j.alcohol.2019.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Susan E Luczak
- Department of Psychology, SGM 501, 3620 S. McClintock Ave, University of Southern California, Los Angeles, CA 90089-1061, USA.
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Rm 2-2352, Bethesda, MD 20892-1540, USA.
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Alessi SM, Barnett NP, Petry NM. Objective continuous monitoring of alcohol consumption for three months among alcohol use disorder treatment outpatients. Alcohol 2019; 81:131-138. [PMID: 30710610 DOI: 10.1016/j.alcohol.2019.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transdermal alcohol sensing technology allows for objective continuous monitoring of alcohol use. The purpose of this study was to characterize alcohol consumption measured with this technology among alcohol use disorder treatment outpatients in two clinical trials. METHODS Participants were community-based alcohol treatment outpatients in usual care (N = 63) during the first three years of studies that monitored drinking with the secure continuous remote alcohol monitor (SCRAMx®) ankle bracelet. Research visits for uploading SCRAMx data occurred every other week in Study 1 (n = 43) and once weekly in Study 2 (n = 20), for 3 months. Staff used timeline follow-back procedures to collect self-reports of drinking frequency and magnitude at each research visit. RESULTS In the 90 days before intake, 85.7% (n = 54) of participants reported consuming alcohol, and consumption occurred on a median (interquartile range) 35.7% (29.0%) of days. During the treatment period, per SCRAMx versus self-report, the percentage who drank was 92.1% (n = 58) versus 46.6% (n = 30), p = .03, and consumption occurred on 16.5% (36.5%) versus 0.0% (21.4%) of days, respectively, p < .001. Median longest duration of abstinence was 26.0 (25.0) versus 39.0 (58.0) days, respectively, p < .001. Breath alcohol concentration, estimated from SCRAMx data, ranged from 0.02 to 0.91 g/dL. CONCLUSIONS This is the first study to quantify alcohol consumption among alcohol treatment outpatients using transdermal sensor technology. Results indicate that most patients drank while in outpatient care. Issues to consider for future applications of this technology and implications for alcohol treatment are discussed.
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Affiliation(s)
- Sheila M Alessi
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-3944, United States.
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Box G-S121-5, Providence, RI 02912, United States.
| | - Nancy M Petry
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-3944, United States
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Roberts W, McKee SA. Mobile alcohol biosensors and pharmacotherapy development research. Alcohol 2019; 81:149-160. [PMID: 31679765 DOI: 10.1016/j.alcohol.2018.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 01/12/2023]
Abstract
Recent advances in biosensor technology herald a major shift in the way alcohol use will be tracked in humans. Wearable biosensors can passively and continuously monitor wearers' alcohol consumption in real time. An important application of these biosensors is to improve the way medication for alcohol use disorder (AUD) is tested in clinical research. Both laboratory-based screening paradigms and clinical trials have methodological problems that impact their efficiency and predictive validity. Medication screening using laboratory-based methods is a resource-intensive assessment of a single episode of behavior in a non-representative setting. Clinical trials rely on participant self-report to document medication-induced changes in drinking behavior. This review describes how mobile biosensors can be leveraged to improve AUD medication development research. We first review the current state of alcohol biosensor technology with a focus on strengths and limitations of the devices. We describe how multiple biosensors can be combined to create a far more detailed record of drinking compared to single biosensor platforms. We then discuss each phase of the medication development pipeline in turn (i.e., phases 1-4) and describe how mobile biosensors can be incorporated in standard medication testing paradigms to improve efficiency and predictive validity. We conclude with discussion of challenges associated with using currently available biosensors for medication testing and recommendations for researchers wishing to incorporate alcohol biosensors into their own research.
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Affiliation(s)
- Walter Roberts
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, United States.
| | - Sherry A McKee
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, United States
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50
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Introduction to a special issue on wearable alcohol biosensors: Development, use, and state of the field. Alcohol 2019; 81:79-81. [PMID: 31299291 DOI: 10.1016/j.alcohol.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022]
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