Transdermal Alcohol Monitors Improve Treatment Compliance

Transdermal alcohol monitors can be useful tools to support the treatment goals of contingency management-based alcohol programs, new research suggests.

Addiction specialists sometimes use a therapeutic approach called contingency management to increase the odds that people in alcohol treatment programs will stick to those programs and improve over time. In a study published in December 2014 in the journal Drug and Alcohol Dependence, researchers from the University of Texas Health Science Center at San Antonio explored the usefulness of devices called transdermal alcohol monitors in helping contingency management-based programs reach their goals. Transdermal alcohol monitors use skin-based measurements to help determine the blood-alcohol concentration of any given person and detect the presence of excessive alcohol intake.

Alcohol Problems and Contingency Management

Contingency management is used across the U.S. and much of the world to help people with diagnosable alcohol problems, as well as people with problems related to the consumption of opioid drugs or medications, stimulant drugs or medications, nicotine/tobacco or marijuana/cannabis. At its core, the approach relies on an incentive system to do such things as increase compliance with program rules and decrease or eliminate the days on which substance use occurs. One form of contingency management, called voucher-based reinforcement, uses valuable, redeemable vouchers as the incentive for abstinence and program involvement. A second form of the therapy, called prize incentives contingency management, uses the opportunity to win cash through drawings held at regular intervals. For participants in either form of the approach, the odds of receiving a benefit go up over time with continued abstinence and program compliance. Conversely, the odds of receiving a benefit typically return to zero if substance use and/or program noncompliance occurs.

Current evidence supports the usefulness of contingency management in helping alcohol treatment programs and other types of substance treatment programs reach their objectives, the National Institute on Drug Abuse reports. In an alcohol program, this approach is often combined with medication, including such options as disulfiram (Antabuse), acamprosate (Campral) and naltrexone (Vivitrol).

Transdermal Alcohol Monitoring

Blood-alcohol concentration (BAC) is the percentage of alcohol circulating in a person’s bloodstream. Under U.S. law, an individual with a BAC of 0.08 percent or higher meets the legal standard for intoxication. Law enforcement officials and other professionals can use a device called a breathalyzer to make a rough but reasonable estimate of any drinker’s blood-alcohol concentration by measuring the amount of alcohol in the breath. However, breathalyzer testing must be administered repeatedly in order to track ongoing changes in alcohol consumption. Transdermal alcohol monitors use measurements of alcohol-related gases passing through the skin to estimate how much alcohol a person has recently consumed. Unlike breathalyzers, these monitors can provide ongoing feedback on alcohol intake.

Usefulness in Contingency Management Compliance

In the study published in Drug and Alcohol Dependence, the University of Texas researchers used a small-scale project to assess the usefulness of transdermal alcohol monitoring in supporting the treatment goals of contingency management-based alcohol programs. During the first four weeks of this project, the 80 participants (all adult alcohol consumers) were encouraged to maintain their normal drinking habits while the researchers merely observed them. During the next 12 weeks, the study enrollees wore transdermal alcohol monitors while participating in contingency management; in line with the principles of this treatment, people whose transdermal readings stayed below a low threshold of alcohol intake received a reward of $50 a week. Additional cash was given for agreeing to use a transdermal monitor and taking part in regular treatment sessions. In a final, third phase of the project, the enrollees reported their alcohol intake for three months while not wearing transdermal monitors.

The researchers concluded that, compared to their typical levels of alcohol intake, the study enrollees substantially reduced their drinking participation while wearing transdermal alcohol monitors as part of contingency management. Specifically, they found that those individuals who qualified as heavy or excessive drinkers before wearing transdermal monitors typically drank heavily on fewer days and had a substantially higher chance of only drinking alcohol in moderate or small amounts, or consuming no alcohol at all.

The study’s authors note that the drinkers involved in their project were not seeking treatment for alcohol problems. However, they believe their findings indicate that the use of transdermal alcohol monitoring can improve the effectiveness of contingency management-based alcohol programs. This conclusion holds true for abstinence-oriented programs, as well as for programs that view both abstinence and substantially reduced alcohol intake as legitimate treatment goals.

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