This study tests whether providing financial rewards based on a blood test result can help people with alcohol-associated liver disease (ALD) stop or reduce their drinking. The blood test is called phosphatidylethanol (PEth), which can detect alcohol use over the past three to four weeks. The financial reward program is called contingency management (CM).
The study has two parts. Part 1 involves one-time interviews and surveys with patients and healthcare providers to understand how a PEth-based CM program could best be delivered in a liver disease clinic. Part 2 is a pilot randomized controlled trial (the REINFORCE Trial) in which participants are randomly assigned to one of two groups: (1) a rewards group that receives escalating financial incentives when PEth results show reduced or no alcohol use, or (2) a monitoring group that receives fixed payments regardless of PEth results. Both groups receive PEth testing and continue their usual medical care. The study will assess whether the rewards program improves alcohol abstinence and reduction at 12 and 24 weeks.'
Adults aged 18 years or older
Diagnosis of alcohol use disorder based on DSM 5 criteria
Diagnosis of alcohol associated liver disease or clinically suspected alcohol related liver injury
Evidence of recent alcohol use or at risk for alcohol relapse
Severe cognitive impairment or medical condition that prevents participation in study procedures
Active psychosis or severe psychiatric instability that would interfere with participation
Current enrollment in another contingency management program targeting alcohol use
Medical instability requiring hospitalization at the time of enrollment