Alaska researchers demonstrate the benefit of offering incentives to curb alcohol dependency in Native communities – State of Reform

Alaska health researchers discussed the effectiveness of using contingency management to curb alcohol dependency in Alaska Native and American Indian communities during the Division of Behavioral Health’s Medications for Addiction Treatment Conference on Tuesday.

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Southcentral Foundation Senior Researcher Dr. Jennifer Shaw discussed a recent study the foundation conducted that utilized incentives to reduce substance use among Alaska Native and American Indian adults. The study’s objective was to determine whether culturally-tailored contingency management—behavioral treatment based on operant conditioning principles—interventions in which incentives were offered for biologically-verified alcohol abstinence would result in increased abstinence among participants.

Many American Indian and Alaska Native communities are disproportionately affected by problems with alcohol use.

“The objective was to assess if contingency management reduces alcohol use among Alaska Native and American Indian adults who qualify for clinical diagnosis of alcohol dependence in 3 communities,” Shaw said.

The study was conducted at 3 American Indian and Alaska Native health care organizations located in Alaska, the Pacific Northwest, and the Northern Plains from 2014 to 2019. Study participants were randomly placed in either a contingency management group or a control group. Contingency management group members received 12 weeks’ worth of incentives for submitting a urine sample indicating alcohol abstinence. Control group members received 12 weeks’ worth of incentives for submitting a urine sample without the requirement of alcohol abstinence.

“They would draw tokens out of a bucket and 50% [of the tokens] had reinforcing messages on them,” Shaw said. “Some [tokens] were for small prizes and some were for large prizes. And 2% were for jumbo prizes like a tent or fishing pole.”

Study results showed that of the 158 participating adults with alcohol dependence, participants who received incentives for alcohol abstinence were more likely to submit alcohol abstinent urine samples compared to those who did not receive incentives for abstinence.

Washington State University Assistant Research Professor Dr. Kait Hirchak also worked on the study.

“Averaged across time, participants in the contingency management group were 70% more likely to submit an alcohol abstinent test,” Hirchak said. “We’re really excited to have this evidence. We got a lot of interest around this in implementing contingency management from tribes around the country. We’ve partnered with Kaufman & Associates as well as an [Addiction Technology Transfer Center] out of California to develop training materials for contingency management training programs.”

Shaw said contingency management intervention is incredibly cost effective, especially compared to other modalities.

“If a person draws [tokens] for every reward, the cost per participant is well under $500,” Shaw said.

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