Translating transdermal alcohol monitoring procedures for contingency management among adults recently arrested for DWI

• Published in: Addictive behaviors 2018-08, Vol.83, p.56-63
• Main Authors: Mathias, Charles W., Hill-Kapturczak, Nathalie, Karns-Wright, Tara E., Mullen, Jillian, Roache, John D., Fell, James C., Dougherty, Donald M.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Alcohol; Alcohol Drinking - metabolism; Alcohol Drinking - prevention & control; Alcohol use; Alcohols; Arrests; Contingency; Contingency management; Contingency planning; Drinking behavior; Driving Under the Influence - prevention & control; Driving while intoxicated; Drunkenness; Female; Humans; Male; Monitoring, Ambulatory - instrumentation; Monitoring, Ambulatory - methods; Pretrial; Pretrial detention; Quality control; Reproducibility of Results; Skin - metabolism; Transdermal alcohol monitor; Transdermal medication
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2018.01.033

Recent developments in alcohol monitoring devices have made it more feasible to use contingency management (CM) procedures to reduce alcohol use. A growing body of literature is demonstrating the effectiveness of CM to reduce alcohol use among community recruited adults wearing transdermal alcohol concentration (TAC) monitoring devices. This article describes the quality improvement process aimed at adapting TAC-informed CM aimed at minimizing alcohol use and maximizing treatment completion. This extends literature to a high-risk population; adults arrested and awaiting trial (pretrial) for criminal charge of driving while intoxicated (DWI). Participants were enrolled during their orientation to pretrial supervision conditions of DWI bond release. At enrollment, participants completed a screening, brief intervention, and referral to treatment; those with high risk alcohol histories were enrolled in an 8-week CM procedure to avoid TAC readings. Four Plan-Do-Study-Act (PDSA) quality improvement cycles were conducted where the TAC cutoff for determining alcohol use, the quantity of reinforcer, and handling of tampers on the transdermal alcohol monitor were manipulated. Across four PDSA cycles, the retention for the full 8-weeks of treatment was increased. The proportion of weeks with alcohol use was not decreased across cycles, the peak TAC values observed during drinking weeks were significantly lower in Cycles 1 and 4 than 3. CM may be developed as a tool for pretrial supervision to be used to increase bond compliance of those arrested for DWI and for others as a method to identify the need for additional judicial services. •Describes four Plan-Do-Study-Act (PDSA) cycles of quality improvement.•Adapting transdermal alcohol concentration monitoring for contingency management.•Treatment retention was greatest under final round of contingency management conditions.•The proportion of weeks with alcohol use remained stable across the four PDSA cycles.