Objective. Behavioral economic (BE) research has demonstrated that increasing the salience of delayed substance-free rewards increases individuals capacity for delaying gratification and allocating behavior towards larger, delayed rewards rather than smaller more immediate reward such as alcohol use. This study aimed to improve the efficacy of outpatient alcohol use disorder (AUD) treatment by adding elements that target BE mechanisms of change. The study hypothesized that the Substance-free Activity Session (SFAS) intervention will reduce alcohol use, alcohol-related problems, relative reinforcement from alcohol use, and increase future orientation compared to an active control at 3-month follow-up. Method. Participants were 41 adults engaged in AUD treatments (all met DSM-5 diagnostic criteria for AUD) at community based outpatient treatment facilities. Following baseline assessment, participants were randomized to either an individual single-session intervention focused on increasing engagement in substance-free activities and future orientation (SFAS) or to an individual sleep hygiene and nutrition education (SHyNE) control condition. Both groups received four weekly text-message reminders of the contents of the session. Participants (68.3% male; 70.7% Caucasian, M age = 38.75, SD = 13.56) reported 27.44 (SD = 14.25) binge drinking episodes in the past 90-days and 9.31 (SD = 6.62) drinks per drinking day at baseline. Results. A series of regression models (negative binomial hurdle and linear regression) that controlled for baseline levels of the outcome indicated that SFAS participants reported fewer binge drinking episodes, and reduced proportionate substance-related (relative to substance-free) reinforcement compared to controls. Further, contrary to our hypothesis, the SFAS condition was associated with less reductions of alcohol-related problems at 3-month follow-up compared to controls. Results did not indicate group differences in future orientation. SFAS participants reported high average session satisfaction ratings 9.08 (SD = .94, on a scale of 1-10). Conclusion. These preliminary pilot study results support the feasibility and acceptability of supplementing already existing outpatient AUD treatment with a single-session intervention plus remote delivery of booster contacts aimed at targeting behavioral economic elements of change. The efficacy results were ambiguous but suggest that the SFAS warrants further study as a potential means of enhancing alcohol treatment efficacy.
Dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.
Meshesha, Lidia, "A RANDOMIZED PILOT TRIAL ASSESSING A BEHAVIORAL ECONOMIC SUPPLEMENT IN ALCOHOL USE DISORDER TREATMENT" (2018). Electronic Theses and Dissertations. 1930.