What’s the cheapest way to get an alcoholic to drink less? According to a new WSU study, giving them small rewards might do the trick.
The study, published Jan. 31 in the American Journal of Psychiatry, is by psychologist Michael McDonell at WSU’s Elson S. Floyd College of Medicine. It looked at the effectiveness of giving people with serious mental illnesses and alcohol abuse problems rewards through a prize drawing for not drinking.
The practice, known as “contingency management,” has been shown to be effective in reducing use among methamphetamine and cocaine users, McDonell said. His study is the first to look at the same reward system for people with alcohol use disorder.
The logic of the reward system is simple. “People with addiction and serious mental health problems are very unlikely to come back unless you give them a reason to come back,” McDonell said.
The study looked at 79 people receiving both mental health and addiction treatment at a community mental health provider in Seattle. People were rewarded by drawing from a bucket with tokens that could be exchanged for different prizes. About half of the tokens had no prize, while 40 percent were good for a small $1 item like shampoo or conditioner.
Less than 10 percent of the tokens could be exchanged for a $20 prize, like a handheld DVD or MP3 player or a gift card. And about 1 in 500 tokens got the client a jumbo prize, including a digital camera or $100 worth of gift cards.
“We want them to just be encouraged and have a little extra motivation. We don’t want to bribe people,” McDonell said.
The clients were split into two groups and had their urine tested for alcohol consumption weekly using an ethyl glucuronide screening, which can detect alcohol use within about the past five days, McDonell said. Those tests are often used in courts, but not typically used in clinical settings.
A control group received prize drawings regardless of their alcohol use. Researchers wanted to make sure people weren’t drinking less just because of the excitement of receiving a reward.
The test group received prize drawings for negative urine tests. At first, they got three drawings for a negative test. If they continued not drinking, the number of draws would increase week by week. At the end of the study, some people were drawing 15 times.
“People would be walking out with bags full of stuff,” McDonell said. Mostly, those were the $1 personal care items, which many clients appreciated because they were homeless or in transitional housing, he said.
The result? People whose rewards were tied to drinking less, rather than simply showing up, cut back their alcohol use more. They were three times more likely to submit a negative urine test and self-reported less drinking and fewer periods of heavy drinking. They also tended to smoke less and reduce use of other drugs compared to the control group. The results held at a three-month follow-up.
McDonell said contingency management programs are a cost-effective way for communities lacking resources to help treat addiction. Many people with co-occurring substance use and mental health problems receive treatment only for mental health, often because providers aren’t equipped with addiction specialists.
“We’re trying to bring easy solutions to treating addiction to community mental health,” he said.
He believes small rewards from the beginning of treatment help convince people to stick with the improvements they’re making.
“We want to catch people with this reward treatment right away so that when they’re new to treatment, they can say, ‘This isn’t quite so bad,’ ” he said.
Many people come from the court system and are used to being punished, not rewarded in treatment.
“They’re used to doing a urine sample and getting in trouble,” McDonell said.
McDonell is currently recruiting for a new study which will look at giving rewards for drinking less in Native American and Alaska Native communities. Although those communities have more people who abstain from alcohol than the general population, people who do drink tend to drink more, making alcohol abuse a serious problem.
That study will recruit people who aren’t necessarily receiving treatment and don’t have severe mental illnesses to see if the results hold.
McDonell hopes to show contingency management can work in rural native communities, where retaining chemical dependency specialists is often harder than in cities.