Effectiveness of contingency management using transdermal alcohol monitoring to reduce heavy drinking among driving while intoxicated offenders

Dougherty, Donald M.; Moon, Tae-Joon; Liang, Yuanyuan · 2023 · openalex

DOI: 10.1111/acer.15180

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Summary

**Research Question and Motivation** This study addresses the lack of effective treatment options for driving while intoxicated (DWI) arrestees, a population with high rates of alcohol use disorder and recidivism. While contingency management (CM) has proven effective for other substances, its application to alcohol has been limited by the difficulty of objectively measuring consumption. The authors investigated whether a CM procedure using transdermal alcohol concentration (TAC) monitoring could reduce heavy drinking among DWI arrestees. The study specifically examined if the effectiveness of CM varied between individuals mandated by the court to wear TAC monitors and those who were not. **Methods** The researchers conducted a randomized controlled trial involving 216 DWI arrestees in Bexar County, Texas. Participants were stratified by mandate status: 72 were "Mandated" (court-ordered to wear TAC monitors as a condition of pretrial release) and 144 were "Non-Mandated" (wore study-provided monitors). Within each mandate group, participants were randomly assigned to either a CM condition or a Control condition. The intervention lasted eight weeks. In the CM group, participants received a $50 weekly incentive if their TAC data showed no heavy drinking days (defined as two or more TAC readings ≥0.02 g/dL) in the previous week. The Control group received yoked payments, meaning their incentives matched the payment patterns of the CM group but were not contingent on their own drinking. All participants wore SCRAM ankle monitors that recorded TAC every 30 minutes. Primary outcomes were the probability of meeting the weekly contingency and the percentage of heavy drinking days, analyzed using mixed-effects logistic regression and linear mixed-effects models. **Results** The study found significant differences in outcomes based on mandate status. Among Non-Mandated participants, the CM group demonstrated a higher and stable probability of meeting the contingency (approximately 65%) compared to the Control group, where the probability declined over time. The gap in probability widened from 16.7% to 24.1% between visits 4 and 8. Similarly, the percentage of heavy drinking days remained low in the Non-Mandated CM group (9.16%–11.37%) but increased over time in the Control group (17.43%–26.59%). In contrast, no significant differences were observed between CM and Control conditions among Mandated participants for either the probability of meeting the contingency or the percentage of heavy drinking days. **Significance** The findings indicate that TAC-based contingency management is effective at reducing heavy drinking among DWI arrestees who are not already subject to strict court-mandated monitoring. For individuals whose drinking was already suppressed by existing judicial contingencies (Mandated participants), the additional CM procedure did not produce further reductions. This suggests that CM is most beneficial for frequent and heavy alcohol users who lack existing external constraints, highlighting the importance of tailoring interventions to the specific regulatory and behavioral contexts of the DWI population.

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• dui enforcement