Contingency management to promote treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: Findings from a pilot randomized controlled trial.

Abstract

Background: Alcohol-related liver disease (ARLD) is a leading cause of preventable death and health inequalities. Evidence-based interventions for comorbid alcohol use disorder (AUD) and ARLD remain limited, and only a small proportion of this clinical population engages with treatment. There is a need to improve patient outcomes by bridging this gap through novel, person-centred interventions. Contingency management (CM) is a psychosocial intervention that involves gradual, increasing incentives upon the completion of treatment-related goals, such as treatment attendance. This single-centre, randomized pilot trial of voucher-based CM was conducted to promote treatment engagement in comorbid AUD and ARLD.

Methods: Thirty service users were recruited from an inpatient setting, offered integrated liver care (ILC) and allocated to ILC only or ILC + CM. Primary outcomes included feasibility criteria (recruitment, study retention post-randomization, completeness of data and protocol fidelity). Secondary outcome data on engagement, alcohol intake, and liver function were also collected. Data were gathered at baseline, post-ILC, and 12 weeks post-ILC and analyzed through descriptive statistics.

Results: The feasibility of the research was subject to challenges inherent to conducting applied health research in a real-world clinical setting. The recruitment and retention rates were 73.20% and 36.70%, respectively. All participants received CM per protocol. An increasing trend in engagement was observed in the ILC + CM compared to ILC only (67% vs. 33%). A trending 76% reduction in alcohol intake and an overall improvement in liver outcomes were observed among participants engaging with the trial, with no significant differences between control and treatment groups.

Conclusion: Overall, the CM intervention was feasible to deliver and appears promising in improving outcomes in individuals with comorbid AUD and ARLD. Aspects related to recruitment, study retention post-randomization, and protocol fidelity need to be further adapted before proceeding with a definitive trial.