A three-arm, Randomised Controlled Trial of the effectiveness and cost-effectiveness of adjunctive medication management and contingency management to enhance adherence to medications for relapse prevention in alcohol dependence.

Alcohol dependence relapse is common following conventional psychosocial interventions. Routine NHS prescription of acamprosate to maintain abstinence from alcohol is now recommended by NICE and its effectiveness in conjunction with psychosocial therapies for relapse prevention is well documented.  

Limited evidence exists to guide clinical practice on effective interventions and NICE have prioritised clinical trials of strategies to increase relapse prevention medication adherence. Supporting and educating patients about the role of acamprosate in relapse prevention through medication management (MM) may improve adherence and increase clinical effectiveness. Pharmacists are ideally placed to deliver MM in this context, though the effectiveness of local pharmacy delivery is currently not known.

Following a simple behavioural reinforcement schedule, contingency management (CM) can be delivered at relatively low cost compared to other psycho/behavioural interventions and with greater clinical effectiveness in substance misuse. If shown to be effective CM has potential to be adopted within NHS services and the pharmacy to enhance alcohol dependence treatment.

Aim of the trial:

• To evaluate the acceptability, effectiveness and cost-effectiveness of adjunctive MM with/without CM in improving acamprosate adherence in alcohol dependence.

Objectives:

• To conduct an internal pilot study to assess the feasibility, recruitment and acceptability of the MM and CM interventions for pharmacists and service users.
• To conduct a definitive three-arm, randomised controlled trial of the effectiveness of MM with and without CM compared to standard support alone (SS) in enhancing adherence to acamprosate
• To estimate the cost effectiveness of MM with and without CM compared to SS alone in enhancing adherence
• To assess the impact of adherence to acamprosate for alcohol dependence relapse prevention on abstinence and reduced alcohol consumption.

Start date: 01/12/2014 End date: 30/11/2018

Funder: NIHR Health Technology Assessment via Kings

Funding: £24,112

back to top