AIM To evaluate the effectiveness of home-based contingency management (CM) in improving abstinence in an incentive-dependent manner among alcoholic individuals. METHODS A 12-week, home-visit (HV) only controlled, randomized incentive-ranging trial of 161 adults with current alcohol dependence was recruited using social network theory techniques. Participants randomly received HV, low- (CM-L) or higher-magnitude CM (CM-H). Community health workers made regular home visits, monitored drinking behavior and delivered CM as appropriate. Two follow-up visits at weeks 13 and 16 were conducted to assess whether abstinence would still be maintained after the interventions discontinued. Rates of continuous reported abstinence (primary), numbers of positive breath samples (secondary) over the intervention period and rates of prolonged reported abstinence (secondary) were evaluated. RESULTS CM did not significantly improve the rates of continuous reported abstinence across the 12-week intervention period (odds ratio (OR) for trend 1.2, 95% confidence interval (CI) 0.7-2.1, P = 0.601). There was a significant reduction, however, in the average number of positive breath samples submitted by the CM-H group (generalized linear model, β -0.5, 95% CI -0.9 to -0.2, P = 0.005). The CM-H arm also had a significantly higher abstinence rate during the follow-up period (OR 3.4, 95% CI 1.3-8.8, P = 0.013). Event history model suggested that the CM-H condition had significantly higher chances of achieving renewed abstinence across the study period (OR 2.0, 95% CI 1.3-3.2, P = 0.003). CONCLUSIONS Home-based CM with sufficient incentive is promising in reducing alcohol use and in improving rates of abstinence over time. Allowing for a certain grace period may better capture the delayed treatment effect of home-based CM.

中文翻译：

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社区卫生工作者提供的基于家庭的应急管理，以提高戒酒能力：一项随机对照试验。

目的评估以家庭为基础的应急管理（CM）在酒精依赖者中以依赖于激励的方式改善禁欲的有效性。方法使用社交网络理论技术，招募了一项为期12周，仅在家访（HV）的对照，随机范围为161位目前有酒精依赖的成年人的激励范围试验。参与者随机接受了HV，低（CM-L）或高幅值CM（CM-H）。社区卫生工作者定期进行家访，监控饮酒行为并酌情分发CM。在第13周和第16周进行了两次随访，以评估中断干预后是否仍能维持节欲。连续报告的禁欲率（主要）评估了干预期内阳性呼吸样本（次要）的数量以及报告的禁欲时间（次要）的持续时间。结果CM并未在12周的干预期内显着提高连续报告的禁欲率（趋势1.2的比值比（OR），95％置信区间（CI）0.7-2.1，P = 0.601）。但是，由CM-H组提交的阳性呼吸样本的平均数量显着减少（通用线性模型，β-0.5，95％CI -0.9至-0.2，P = 0.005）。在随访期间，CM-H组的戒断率也明显更高（OR 3.4，95％CI 1.3-8.8，P = 0.013）。事件历史模型表明，在整个研究期间，CM-H病患获得重新禁欲的机会明显更高（OR 2.0，95％CI 1.3-3.2，P = 0.003）。结论具有足够诱因的家用CM有望减少酒精使用并提高戒酒率。允许一定的宽限期可以更好地捕获家庭CM的延迟治疗效果。