Incentives can scale back alcohol use amongst American Indian and Alaska Native individuals

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Incentives can reduce alcohol use among American Indian and Alaska Native people

Emergency management offers incentives to maintain abstinence, which is achieved through raffles with tokens. Tokens contain positive expressions such as "good job" or can be exchanged for prizes between $ 1 and $ 80. Photo credit: Cori Kogan, WSU Health Sciences Spokane

The researchers' results showed that participants who received an inexpensive, easy-to-administer intervention that used small prizes and other incentives to reward abstinence from alcohol could serve as an effective tool in reducing alcohol use in Native American and indigenous communities in Alaska . new research suggests.

The study, published today in JAMA Psychiatry, tested a culturally adapted version of an intervention known as emergency management in Native American and Alaskan adults diagnosed with alcohol addiction, a severe form of alcohol use disorder. The researchers' results showed that participants who were given incentives to reward alcohol abstinence were 70% more likely than control participants to test negative for alcohol use.

"Emergency management can help people generate interest in reducing their alcohol consumption in positive ways, building confidence, feeling connected, and genuinely recognizing their journey and recovery," said study co-author Katherine Hirchak. a descendant of the Eastern Shoshone Tribe and an assistant professor at Elson S. Floyd College of Medicine at Washington State University. She said the intervention's positive approach fits well with Native American values ​​and helps offset the stigma of Alaskan and Native Alaskan alcohol use, a complex problem that defies generalization.

The study was developed and conducted in collaboration with three native communities in urban and rural areas in Alaska, the Pacific Northwest, and the Northern Plains. It is the first multi-site study to test the use of emergency management to reduce alcohol consumption in local adults. What follows is another study recently published by the researchers in the journal Addiction, which showed similarly promising results for a single rural reserve in the northern plains.

"Together, these two studies provide evidence that this intervention would work in a diverse group of indigenous communities and could be used as part of a comprehensive addiction treatment system to reduce alcohol-related inequalities in indigenous communities," said lead author Michael McDonell, professor at Washington State University's Elson S. Floyd College of Medicine. He added that the studies were also two of the largest of these interventions for alcohol use disorders in any population.

As part of the multisite study, the researchers conducted a 12-week study that enrolled 158 participants who were recruited from the three sites. Participants were randomized into an emergency management intervention that incentivized the giving of alcohol-negative urine samples during twice-weekly visits or a control intervention that incentivized simply giving urine samples without abstaining from alcohol.

Alcohol abstinence was checked by ethyl glucuronide (ETG) tests, which can be used to detect the presence of alcohol in the urine for up to three days. Incentives were given through raffles, in which the participants withdrew tokens that either contained positive sentences such as "good work" or could be exchanged for prizes with a value between 1 and 80 US dollars. Prizes included gift cards, culturally significant items like fishing gear or pearl accessories, and practical items like shampoo and clothing. For the participants in the emergency management intervention, the number of competitions increased with each visit with the length of their abstinence.

The researchers' finding that contingency management participants were 70% more likely to submit an alcohol-negative urine sample is a modest but significant effect, which, according to McDonell, is compounded by the low cost of the intervention – with the mean total cost of prices per person only $ 50 – and its potential public health benefits to a large group of people. The intervention can be carried out with minimal staff training and can be carried out from any location. Recently introduced rapid urine tests have eliminated the need for expensive urinalysis equipment used in the study and removed a potential obstacle to the widespread adoption of emergency management.

McDonell said he is already in contact with various tribes and states interested in training communities on how to use this approach. Researchers and staff at the Southcentral Foundation – an Alaskan nonprofit health system that served as one of the three study sites – had the opportunity to see firsthand the benefits of the intervention. The Southcentral Foundation's Four Directions Outpatient Treatment Center intends to add it to its intensive outpatient treatment program for substance use.

"Participants told us that their experience of participating in the study changed their lives," said Jennifer Shaw, senior researcher at the Southcentral Foundation and co-author of the study. "Many said the effects of the intervention on their self-efficacy and relationships were incredibly positive, which really validates the Nuka System of Care, the relationship-based model of health care developed by Native Alaska people."

Rewards treat alcohol abuse in people with mental illness

More information:
JAMA Psychiatry (2021). DOI: 10.1001 / Jamapsychiatry.2020.4768

Provided by
Washington State University

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