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Keywords:

  • Alcohol;
  • cellular phone;
  • cessation;
  • contingency management;
  • intervention;
  • technology.

Alessi & Petry [1] examined if cellular phone technology could be used to provide contingency management (CM)-based reinforcement for alcohol abstinence by comparing two randomized conditions: (1) CM for submitting video-recorded alcohol breath tests (BrAC) via cellular phones regardless of the results and (2) the same condition plus escalating vouchers for negative alcohol breaths (n-BrAC). They found that the percentage of n-BrAC and the longest duration of consecutive n-BrAC were greater in the group that received CM for alcohol abstinence. The strength of this study is the innovative use of the popular and widely used cellular phone technology, which is cost-effective and which enables the monitoring of drinking in a real-world setting while providing immediate reinforcement for alcohol abstinence. This innovative use of the cellular phone may facilitate the adoption of CM intervention in diverse clinical settings.

CM is considered an effective treatment strategy for promoting abstinence from licit and illicit substance use [2, 3]; however, the application of this intervention is impeded by several factors, thus raising the question of whether the intervention can be applied in the real world. A particular challenge in using CM to reduce alcohol use is the limited technology available to test for alcohol use. Current breath alcohol readings can only determine alcohol consumption 4–12 hours prior to testing [4], so they must be taken several times a day to detect use, thereby making the application of CM for alcohol abstinence in the out-patient setting almost impossible. This is concerning, given that alcohol is the most common substance for which patients seek substance abuse treatment [5].

Clearly, an accessible, feasible and effective way to deliver CM to reinforce abstinence from alcohol is needed, and the use of cellular phone technology may be one way to accomplish this goal. Alessi & Petry [1] have developed a novel way of using portable technology such as cellular phones to test blood alcohol concentration. Importantly, this technique was used to monitor drinking at relevant contexts and times. Probes for alcohol tests were clustered during the weekends and weeknights, where drinking is most likely to occur. Such modification may make the use of technology to deliver CM more practical.

CM has also been criticized for financial and administrative burdens. The CM participants in Alessi & Petry's [1] study earned, on average, $219 (±$106) in vouchers, which is comparable to the amount earned in previous CM trials for alcohol abstinence [6] and lower than the previous voucher CM system of approximately $1000 [7]. Using cellular phones to deliver CM may help to even further lower other related costs that are often not reported in published studies, such as the cost of space and personnel time needed to administer the daily CM procedures for the duration of 8–12 weeks. It is also less demanding on participants, because it reduces frequent travel required to the research facility to verify abstinence and receive reinforcements. The cost of a cellular phone plan per month per phone for 200 minutes of talk, restricted to study numbers and unlimited texting, was $27. The relative affordability of cellular phone packages can reduce the financial and time constraints experienced by the participants and staff and will ultimately be cost-effective in the long term.

Alessi & Petry [1] are the first to use cellular phone technology to deliver CM for alcohol abstinence, and their study may serve as a model for other researchers to combine rigorous methodology, theory and modern technology to narrow the research-to-practice gap. Future studies should assess whether CM procedures using cellular phones can yield outcomes greater the standard CM procedures, and whether it can be used to reach a variety of populations. Future improvements could include relapse prevention in the long term.

Declaration of interests

None.

References

  1. Top of page
  2. References
  • 1
    Alessi S. M., Petry N. M. A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. Addiction 2013; 108: 900909.
  • 2
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    Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment Episode Data Set (TEDS). 1998–2008. National Admissions to Substance Abuse Treatment Services. HHS Publication no. (SMA) 09-4471. Rockville, MD: SAMHSA; 2010.
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  • 7
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