Transdermal Alcohol Monitoring Research Articles

Accuracy of transdermal alcohol monitoring devices in a laboratory setting.

The development of transdermal alcohol sensors (TASs) presents a new method to monitor alcohol consumption with the ability to objectively measure data 24/7. We aimed to evaluate the accuracy of two TASs (BACtrack Skyn and Smart Start BARE) in a laboratory setting. Thirty-two adults received a dose of ethanol 0.56g/kg body weight as a 20% solution while wearing the two TASs and provided Breath Alcohol Concentration (BrAC) measurements for 3.5h postalcohol consumption. Pearson's correlations and repeated measures analysis of variance tests were conducted on the peak, time-to-peak, and area under the curve data. Bland-Altman plots were derived. A time series analysis and cross-correlations were conducted to adjust for time lag. Both TASs were able to detect alcohol and increase within 20min. BrAC peaked significantly quicker than Skyn and BARE. BrAC and Skyn peaks were negatively significantly correlated (r = -0.381, P = .035, n = 31), while Skyn and BARE peaks were positively significantly correlated (r = 0.380, P = .038, n = 30). Repeated measures analysis of variance found a significant difference between BrAC, Skyn, and BARE (F(1.946, 852.301) = 459.873, P < .001)). A time series analysis found when BrAC-Skyn and BrAC-BARE were adjusted for the delay to peak, and there was still a significant difference. Failure rates: 1.7% (Skyn) and 4.8% (BARE). Some evidence was obtained for TAS validity as both consistently detected alcohol. Failure rates and time lag show improvements in older device generations. However, neither TAS presented strong equivalence to the breathalyser even when the lag time was adjusted. With further testing and technology advancements, TAS could be a potential alcohol monitoring tool. Two of the newest TAS devices were worn in laboratory conditions for one afternoon to compare their accuracy of alcohol monitoring to a breathalyser. Findings suggest that the two TASs (BACtrack Skyn and SmartStart BARE) recorded significantly similar data postalcohol consumption, but not with the breathalyser.

Effectiveness of contingency management using transdermal alcohol monitoring to reduce heavy drinking among driving while intoxicated (DWI) arrestees: A randomized controlled trial.

Driving while intoxicated (DWI) is a serious public health problem. However, treatment for DWI arrestees is not readily available. This study examines the effectiveness of a contingency management (CM) procedure using transdermal alcohol concentration (TAC) monitoring to reduce drinking among DWI arrestees. The study participants were 216 DWI arrestees under pretrial and included both Mandated participants undergoing court-ordered TAC monitoring and Non-Mandated participants wearing a study-provided TAC monitor. Participants were randomly assigned to either a CM (Mandated = 35; Non-Mandated = 74) or a Control condition (Mandated = 37; Non-Mandated = 70) and completed the 8-week intervention. CM participants received $50/week for not exceeding a TAC of 0.02 g/dL during the previous week. Payments to Controls were yoked to the CM group. Among Non-Mandated participants, the probability of meeting the contingency was higher and remained stable (about 65%) over time in the CM group, whereas the probability was lower and declined in the Control group, widening the gaps in the probability between the study conditions (16.7%-24.1% greater in the CM group from visit 4 to 8, all p < 0.05). Among Mandated participants, the probability was not significantly different between conditions (p = 0.06-0.95). Furthermore, among Non-Mandated participants, the percentage of heavy drinking days remained low (9.16%-11.37%) in the CM group, whereas it was greater and increased over time (17.43%-26.59%) in the Control group. In Mandated participants, no significant differences in percent heavy drinking days were observed between conditions (p = 0.07-0.10). We found that contingency effects on alcohol use are more pronounced among frequent and heavy alcohol users, i.e., Non-Mandated DWI arrestees. However, for individuals whose drinking was already suppressed by existing contingencies (i.e., court-mandated TAC monitoring), our CM procedure did notproduce additional reductions in drinking.

Phosphatidylethanol vs Transdermal Alcohol Monitoring for Detecting Alcohol Consumption Among Adults

Alcohol biomarkers can improve detection of heavy alcohol use in clinical care, yet cutoffs for phosphatidylethanol (PEth), a blood biomarker, have not been established. To determine the optimal cutoff for PEth for heavy alcohol consumption in a study of middle-age and older adults. This was a 4-week diagnostic study of adults with paroxysmal atrial fibrillation (AF) and current alcohol consumption, recruited from general cardiology and cardiac electrophysiology outpatient clinics from September 2014 to September 2019. Data were analyzed from October 2021 to March 2022. The main aim was to determine the optimal PEth cutoff for heavy alcohol consumption, using the Secure Continuous Remote Alcohol Monitor (SCRAM) to measure transdermal alcohol. Area under the curve (AUC) for PEth-detected compared with SCRAM-detected heavy alcohol consumption in any week over the prior 4 weeks (ie, ≥3 [women] and ≥4 [men] episodes) or any estimated breath alcohol of 0.08% or greater in any week, and the PEth cutoff was calculated using the Youden J statistic. Similar analyses were conducted comparing PEth with individual drinks reported by pressing an event monitor, retrospective self-report via the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and using 2-week look-backs. In this diagnostic study of 64 patients with both PEth and SCRAM measures over 4 weeks (54 [84.4%] men; mean age, 65.5 [95% CI, 62.6-68.5] years; 51 [79.7%] White), 31 (48.4%) had any SCRAM-detected heavy alcohol consumption over the 4 weeks, and the median (IQR) PEth at 4 weeks was 23 ng/mL (<limit of quantification to 60 ng/mL). The AUC for PEth vs any SCRAM-detected heavy alcohol consumption was 0.83 (95% CI, 0.72-0.93). The optimal PEth cutoff was 18.5 ng/mL (AUC, 0.83; 95% CI, 0.72-0.93), with sensitivity of 83.9% (95% CI, 66.3%-94.5%) and specificity of 72.7% (95% CI, 54.5%-86.7%). The PEth test characteristics by individual drink reporting using the event monitors and by the AUDIT-C, and by these measures and by SCRAM collected for 2-week intervals, were similar to those compared with the 4-week SCRAM. In a predominately middle-age and older White male population, PEth compared well with SCRAM. A PEth cutoff of 18.5 ng/mL (or rounded to 20 ng/mL, a recommended PEth cutoff for significant alcohol consumption) can be used in clinical care to detect heavy alcohol consumption in middle-age and older men.

Reduced alcohol use increases drink-refusal self-efficacy: Evidence from a contingency management study for DWI arrestees

BackgroundSeveral therapies and interventions to reduce drinking first target drink-refusal self-efficacy (DRSE) to influence drinking behavior. While higher self-efficacy scores are correlated with better outcomes, it is unclear that increased self-efficacy is the causative step leading to improved outcomes. Instead, this correlation may result from reduced drinking that increased self-efficacy. The current study sought to understand how changes in drinking behavior can influence DRSE. MethodsData were from 211 driving while intoxicated (DWI) arrestees participating in an 8-week contingency management (CM) study to reduce drinking. Some of participants were mandated by the courts to wear transdermal alcohol monitoring devices (Mandated group) and some were not mandated (Non Mandated group). All wore a transdermal alcohol monitor during the 8-week study and were randomized to CM or a Control condition stratified by the mandate group. Participants completed weekly assessments of DRSE. Group-based trajectory-modeling identified three drinking behavior trajectory groups. ResultsWhile there were no differences in baseline DRSE between the three trajectory groups, participants in the low- and moderate-frequency drinking behavior groups significantly increased DRSE across the study. ConclusionThe present study indicates that being able to maintain abstinence or reduce heavy drinking may increase DRSE.

TRANSDERMAL ALCOHOL CONCENTRATION (TAC) MONITORING SYSTEM IN THE CONTEXT OF PROBATION: A LEGAL AND PEDAGOGICAL ANALYSIS. THE CASE OF POLAND

Excessive alcohol consumption has a number of negative consequences for both an individual and their immediate environment. Development in its broadest sense involves not only economic or social development, but also the possibility of using new equipment to minimise the negative consequences of various social phenomena, including alcohol dependence. One of the opportunities to leverage the changes associated with both social and technological developments is precisely the implementation of the Transdermal Alcohol Monitoring System (hereinafter referred to as the TMSA) into the practice of probation officers in cases related to the supervision of alcohol-dependent individuals. The main objective of the article is an attempt to make a (basic) analysis of legal acts with simultaneous reference to pedagogical aspects in terms of the possibility of implementing the TMSA system in the guardianship service. The paper uses a descriptive as well as a theoretical and legal method.

Embedded Transdermal Alcohol Detection via a Finger Using SnO2 Gas Sensors.

In this paper, we report the fabrication and characterization of a portable transdermal alcohol sensing device via a human finger, using tin dioxide (SnO2) chemoresistive gas sensors. Compared to conventional detectors, this non-invasive technique allowed us the continuous monitoring of alcohol with low cost and simple fabrication process. The sensing layers used in this work were fabricated by using the reactive radio frequency (RF) magnetron sputtering technique. Their structure and morphology were investigated by means of X-ray spectroscopy (XRD) and scanning electron microscopy (SEM), respectively. The results indicated that the annealing time has an important impact on the sensor sensitivity. Before performing the transdermal measurements, the sensors were exposed to a wide range of ethanol concentrations and the results displayed good responses with high sensitivity, stability, and a rapid detection time. Moreover, against high relative humidity (50% and 70%), the sensors remained resistant by showing a slight change in their gas sensing performances. A volunteer (an adult researcher from our volunteer group) drank 50 mL of tequila in order to realize the transdermal alcohol monitoring. Fifteen minutes later, the volunteer’s skin started to evacuate alcohol and the sensor resistance began to decline. Simultaneously, breath alcohol measurements were attained using a DRAGER 6820 certified breathalyzer. The results demonstrated a clear correlation between the alcohol concentration in the blood, breath, and via perspiration, which validated the embedded transdermal alcohol device reported in this work.

(Invited) Transdermal Alcohol Monitoring with a Printed Amperometric Sensor

(Invited) Transdermal Alcohol Monitoring with a Printed Amperometric Sensor

A Discreet Wearable IoT Sensor for Continuous Transdermal Alcohol Monitoring - Challenges and Opportunities.

Non-invasive continuous alcohol (ethanol) monitoring has potential applications in both population research and in clinical management of acute alcohol intoxication or chronic alcoholism. Current wearable monitors based on transdermal alcohol content (TAC) sensing have limited accessibility and blood alcohol content (BAC) quantification accuracy. Here we describe the development of a self-contained discreet wearable transdermal alcohol (TAC) sensor in the form of a wristband or armband. This sensor can detect vapor-phase alcohol in perspiration from 0.09 ppm (equivalent to 0.09 mg/dL sweat alcohol concentration at 25 °C under Henry's Law equilibrium) to over 500 ppm at one-minute time resolution. Additionally, a digital sensor was employed to monitor the temperature and humidity levels inside the sensing chamber. Two male human subjects were recruited to conduct studies with alcohol consumption using calibrated prototype TAC sensors to validate the performance. Our preliminary data demonstrated that, under well-controlled conditions, this sensor can acquire TAC curves at low doses (1-2 standard drinks). Moreover, TAC data for different doses can be easily distinguished. However, substantial interpersonal and intrapersonal variabilities in measurement data were also observed in experiments with less controlled conditions. Our observations suggest that perspiration rate might be an important contributing factor to these variabilities. Further studies with sufficient sample sizes are required to validate and characterize the impact of different perspiration rates on TAC sensors, which may inform more reproducible and accurate sensor designs in the future.

Transdermal Alcohol Monitoring with a Printed Amperometric Gas Sensor

Introduction We report development of a prototype transdermal ethanol (EtOH) monitor, in wristwatch format, to provide a modern device for consumer, clinical and law enforcement applications. Our vision is an attractive, comfortable smart watch, which will measure transdermal alcohol concentration (TAC) and predict blood alcohol concentration (BAC) during drinking. Current commercially available alcohol monitors are bulky, ankle-fixed devices, predominantly used in court-ordered monitoring and some research studies [1]. There has been little advancement in wearability, comfort and analytical performance of these devices. Our long-term goal is to realize a new generation of wearable monitor that combines a sensitive ethanol measurement and smartwatch capabilities in a comfortable and attractive package. This device could greatly expand the possible applications employing this technology. Experimental Watch Fabrication. The sensor platform was fabricated based on a scaled down version of our dual gas sensor platform and printed amperometric gas sensor [2, 3]. The simple prototype device contains a single EtOH sensor, analog front end, 24 bit ADC, Bluetooth LE chip and T/P/RH sensor. The board is contained in a commercially available wristwatch enclosure (BodyCase B1606117) as in Fig. 1. Initial tests of linearity and S/N showed that the circuit was linear over at least 0-300 ppm EtOH at 25 C (R2 = 0.9996 – 0.9998 for 4 boards) with sensitivity 23 ± 2 nA/ppm (for 4 boards) and limit of detection (LOD) 0.26 ± 0.06 ppm.Laboratory Testing. A flow cell was designed to deliver 0 – 0.4 w/o EtOH (simulated BAC) through a Strat-M membrane, which served as a skin surrogate [4]. EtOH solutions in phosphate buffered saline pH 7.1 were used. The cell was configured such that EtOH permeated the Strat-M, with vapor entering the headspace above to which the watch was interfaced. Results and Conclusions Flow Cell Tests. EtOH steps between 0 and 0.4 %EtOH (simulated BAC) were applied with 30 min exposure at each step. A 6 hr stability test was included. High stability and S/N were demonstrated. The EtOH concentrations in simulated BAC solutions were standardized and calibrated to headspace vapor phase concentrations, giving a calibration curve for %EtOH in the PBS buffer (simulated %BAC) as a function of measured EtOH (ppm EtOH) in headspace above the membrane. For two devices, we obtained highly linear calibrations (R2 = 0.9983, 0.9992, respectively) with slope of 0.0013% and 0.0011% BAC/ppm EtOH, with near zero intercepts (-0.009 and -0.006 %BAC, respectively). From these two tests and the baseline noise we determined a limit of detection (LOD) of ±0.005% BAC. In later tests (e.g., Fig. 2) the LOD was considerably improved. The 6 hr stability test at 0.12% EtOH showed very stable output of 0.116 ±0.003 % EtOH.Human Tests. An example of real transdermal alcohol measurement using the watch prototype on a human subject is shown in Fig. 2. A male volunteer ingested six 6 oz. aliquots of 5 v/o alcoholic beverage over ca. 1 hr. Two different watches were used, one fixed to each wrist. The measured temperature at the devices was typically in the range 28 – 34 C during tests. The data in Fig. 2 are not temperature compensated. A commercial BACtrack Trace breathalyzer was used to collect contemporaneous breath alcohol data (BrAC).The TAC measurements taken on two wrists correlated quite well with each other. The TAC values tracked BrAC trend qualitatively, but with a shift to longer times, with the peak BrAC occurring ca. 1.5 hours before the peak TAC value. In other tests we have also observed lags on the order 30 min to 2 hr for TAC vs. BrAC measures. This lag is well-known for transdermal ethanol measurements [5] and presents a challenge for reliable instantaneous BAC prediction from TAC data. We note that the lag can depend on many factors including person-to-person variability of skin permeability, presence of sweat (humidity), food consumption and variable rates of alcohol consumption and metabolism, to name a few examples. Mechanical effects such as sudden movements and impacts can also affect the measurement.We demonstrated use of a printed amperometric sensor for TAC measurement. Controlled clinical trials are currently being performed in collaboration with Boston Medical Center. The ultimate goal is to reliably predict BAC from TAC data across a broad range of individuals and use cases.

Monitoring alcohol use in heavy drinking soup kitchen attendees.

Rates of heavy alcohol use in soup kitchen attendees range from 30% to 38%, but these data are based entirely on self-reported drinking. Little is known about the intensity or frequency of drinking in this population. We assessed alcohol use transdermally every 30min over a 3-week period among heavy drinkers who attended local soup kitchens. In addition to transdermal alcohol monitoring, participants were randomly assigned to daily breath alcohol monitoring with or without reinforcement for alcohol-negative breath samples (BrAC). Analyses assessed feasibility of transdermal monitoring and examined alcohol use based on BrAC, transdermal, and self-report data, as well as effect sizes for these metrics based on group assignment. Nineteen participants completed the 21-day monitoring period in full; three persons removed the anklet 3-16 days early due to hospitalization, impending hospitalization, or incarceration. Participants reported minimal impacts of the monitors, and severity ratings of side effects were mild. When using BrAC, transdermal, and self-report data, the percentage of non-drinking days was 93%, 58%, and 57%, and the longest duration of consecutive non-drinking days averaged 10.3, 7.2, and 5.7 days, respectively. About half of drinking days involved heavy drinking (5+drinks). Self-report and transdermal drinking days correlated significantly, p<.001, but neither index was associated with BrAC. Group comparisons indicate small-to-moderate sized effects of reinforcement compared to no reinforcement for increasing the proportion of alcohol-negative breath samples and durations of consecutive non-drinking samples during the study when BrAC was the metric. Transdermal data and self-report data indicated a more complex pattern. Reinforcement participants drank more often but at lower quantities than monitoring (control) participants per both transdermal and self-report data. These data suggest that transdermal monitors are well tolerated and document substantial heavy drinking in this population. Soup kitchens users are in need of alcohol interventions, and soup kitchens may represent a novel opportunistic setting for intervention delivery for an important and growing health disparities population.

The correspondence between transdermal alcohol monitoring and daily self-reported alcohol consumption

Alcohol consumption is typically assessed via self-report methods, though there are concerns over the accuracy of this information. Transdermal alcohol monitoring can passively and continuously measure alcohol consumption with minimal interference in daily life. The current study examines the correspondence between daily self-reported alcohol consumption and transdermal alcohol monitors. Thirty-two healthy men (n = 16) and women (n = 16) wore a transdermal alcohol monitor for 28 days. Participants were instructed to drink as they usually do and prompted daily with a survey link to report yesterday's drinking. Data analyses focused on the following comparisons: (1) the overall correspondence between self-reported drinking and TAC readings; (2) the sensitivity of various TAC criteria thresholds to detect self-reported drinking (TAC thresholds of none, low, moderate, and heavy); and (3) the risks of false positive TAC findings using self-reported drinking as the Gold Standard. Participants self-reported drinking a total of 324 days, of which, TAC events were detected on 212 days (65.4%). When participants self-reported not drinking (399 days), zero TAC was also found on 366 days (92%). The correspondence between self-reported drinking and transdermal concentrations tended to be good: overall, when self-reported drinking was reported, TAC also detected drinking 65.4% of the time.

Transdermal alcohol monitoring combined with contingency management for driving while impaired offenders: A pilot randomized controlled study

ABSTRACTObjectives: In a pilot randomized controlled trial of contingency management (CM) and transdermal alcohol monitoring (TAM) with offenders driving while impaired by alcohol (DWI), perceptions regarding the acceptability of a TAM device, recruitment issues, and the impact of CM and TAM on alcohol use over a 6-week period were evaluated. The results aimed to inform the design of future trials and programs involving CM and TAM for DWI remediation.Methods: TAM devices were affixed to 37 voluntary, community-recruited male DWI offenders with problem alcohol use. They were randomized to one of 3 groups: (1) CM; (2) alcohol use feedback (FB); and (3) TAM device only (CTL). Quantitative and qualitative data were gathered on the acceptability of TAM devices and recruitment, and alcohol use was monitored via TAM and self-report.Results: The TAM device was perceived positively, with benefits for reducing drinking noted. Nevertheless, some of its inconveniences appeared to influence participant recruitment and attrition, including its large size and limited water resistance. TAM data revealed a significant main effect of time for reduction in weekly peak transdermal alcohol concentration (P = .02), with a decrease between means of weeks 1 and 6 (M = 0.15, SE = 0.02 vs. M = 0.09, SE = 0.02; P = .005). No significant group effect was detected.Conclusions: TAM is a viable adjunct to CM with DWI offenders, though the TAM device used here may influence both study recruitment and adherence. These findings can guide the design of future studies into CM and TAM for DWI remediation.

Translating transdermal alcohol monitoring procedures for contingency management among adults recently arrested for DWI

Recent developments in alcohol monitoring devices have made it more feasible to use contingency management (CM) procedures to reduce alcohol use. A growing body of literature is demonstrating the effectiveness of CM to reduce alcohol use among community recruited adults wearing transdermal alcohol concentration (TAC) monitoring devices. This article describes the quality improvement process aimed at adapting TAC-informed CM aimed at minimizing alcohol use and maximizing treatment completion. This extends literature to a high-risk population; adults arrested and awaiting trial (pretrial) for criminal charge of driving while intoxicated (DWI). Participants were enrolled during their orientation to pretrial supervision conditions of DWI bond release. At enrollment, participants completed a screening, brief intervention, and referral to treatment; those with high risk alcohol histories were enrolled in an 8-week CM procedure to avoid TAC readings. Four Plan-Do-Study-Act (PDSA) quality improvement cycles were conducted where the TAC cutoff for determining alcohol use, the quantity of reinforcer, and handling of tampers on the transdermal alcohol monitor were manipulated. Across four PDSA cycles, the retention for the full 8-weeks of treatment was increased. The proportion of weeks with alcohol use was not decreased across cycles, the peak TAC values observed during drinking weeks were significantly lower in Cycles 1 and 4 than 3. CM may be developed as a tool for pretrial supervision to be used to increase bond compliance of those arrested for DWI and for others as a method to identify the need for additional judicial services.

The Potential Clinical Utility of Transdermal Alcohol Monitoring Data to Estimate the Number of Alcoholic Drinks Consumed.

Transdermal alcohol monitoring is used extensively in forensic settings to identify whether individuals have violated court-ordered mandates to abstain from drinking. Despite widespread use in that setting, comparatively few studies have explored the clinical utility of transdermal alcohol monitoring. Furthermore, of the few studies conducted, most have relied on the forensically established conservative criteria to identify whether or not a drinking episode has occurred. Here, we explore how transdermal alcohol monitoring data can be used to estimate more clinically meaningful parameters relevant to clinical treatment programs. We developed a procedure to use transdermal data to objectively estimate the number of standardized drinks an individual has consumed. Participants included 46 men and women who consumed 1 to 5 beers within 2 hours in the laboratory on separate days while wearing devices to monitor transdermal alcohol concentrations (TAC). A mathematical model was derived to estimate the number of standardized alcohol drinks consumed, which included a number of variables (time-to-peak TAC, area under the TAC curve, and sex). The model was then validated by applying it to data from a separate study. Our results indicate that transdermal alcohol devices can be used to estimate the number of standard drinks consumed. Objective methods characterizing both the level of intoxication achieved and the number of drinks consumed, such as transdermal alcohol monitoring, could be useful in both research and treatment settings.

Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking

BackgroundRecently, we demonstrated that transdermal alcohol monitors could be used in a contingency management procedure to reduce problematic drinking; the frequency of self-reported heavy/moderate drinking days decreased and days of no to low drinking increased. These effects persisted for three months after intervention. In the current report, we used the transdermal alcohol concentration (TAC) data collected prior to and during the contingency management procedure to provide a detailed characterization of objectively measured alcohol use. MethodsDrinkers (n=80) who frequently engaged in risky drinking behaviors were recruited and participated in three study phases: a 4-week Observation phase where participants drank as usual; a 12-week Contingency Management phase where participants received $50 each week when TAC did not exceed 0.03g/dl; and a 3-month Follow-up phase where self-reported alcohol consumption was monitored. Transdermal monitors were worn during the first two phases, where each week they recived $105 for visiting the clinic and wearing the monitor. Outcomes focused on using TAC data to objectively characterize drinking and were used to classify drinking levels as either no, low, moderate, or heavy drinking as a function of weeks and day of week. ResultsCompared to the Observation phase, TAC data indicated that episodes of heavy drinking days during the Contingency Management phase were reduced and episodes of no drinking and low to moderate drinking increased. ConclusionsThese results lend further support for linking transdermal alcohol monitoring with contingency management interventions. Collectively, studies to date indicate that interventions like these may be useful for both abstinence and moderation-based programs.

Examining the experience and effectiveness of continuous transdermal alcohol monitoring with a female student population

Introduction Transdermal alcohol monitoring anklets continuously measure unmetabolized alcohol secreted in sweat. This study explored the drinking behaviour of female students, their experiences of wearing an anklet, and the potential impact of different forms of feedback on drinking behaviour. Methods A mixed methods design was used. Fifty-six female students completed an online suite of questionnaires and were …

Use of continuous transdermal alcohol monitoring during a contingency management procedure to reduce excessive alcohol use

BackgroundResearch on contingency management to treat excessive alcohol use is limited due to feasibility issues with monitoring adherence. This study examined the effectiveness of using transdermal alcohol monitoring as a continuous measure of alcohol use to implement financial contingencies to reduce heavy drinking. MethodsTwenty-six male and female drinkers (from 21 to 39 years old) were recruited from the community. Participants were randomly assigned to one of the two treatment sequences. Sequence 1 received 4 weeks of no financial contingency (i.e., $0) drinking followed by 4 weeks each of $25 and then $50 contingency management; Sequence 2 received 4 weeks of $25 contingency management followed by 4 weeks each of no contingency (i.e., $0) and then $50 contingency management. During the $25 and $50 contingency management conditions, participants were paid each week when the Secure Continuous Remote Alcohol Monitor (SCRAM-II™) identified no heavy drinking days. ResultsParticipants in both contingency management conditions had fewer drinking episodes and reduced frequencies of heavy drinking compared to the $0 condition. Participants randomized to Sequence 2 (receiving $25 contingency before the $0 condition) exhibited less frequent drinking and less heavy drinking in the $0 condition compared to participants from Sequence 1. ConclusionsTransdermal alcohol monitoring can be used to implement contingency management programs to reduce excessive alcohol consumption.

Accounting for sex-related differences in the estimation of breath alcohol concentrations using transdermal alcohol monitoring.

Previously, we reported methods to estimate peak breath alcohol concentrations (BrAC) from transdermal alcohol concentrations (TAC) under conditions where alcohol consumption was controlled to produce similar BrAC levels in both sexes. This study characterized differences in the relationship between BrAC and TAC as a function of sex and developed a model to predict peak BrAC that accounts for known sex differences in peak BrAC. TAC and BrAC were monitored during the consumption of a varying number of beers on different days. Both men (n=11) and women (n=10) consumed one, two, three, four, and five beers at the same rate in a 2-h period. Sex and sex-related variables were considered for inclusion in a multilevel model to develop an equation to estimate peak BrAC levels from TAC. While peak BrAC levels were significantly higher in women than men, sex differences were not significant in observed TAC levels. This lack of correspondence was evidenced by significant sex differences in the relationship between peak TAC and peak BrAC. The best model to estimate peak BrAC accounted for sex-related differences by including peak TAC, time-to-peak TAC, and sex. This model was further validated using previously collected data. The relationship between peak TAC and actual peak BrAC differs between men and women, and these differences can be accounted for in a statistical model to better estimate peak BrAC. Further studies are required to extend these estimates of peak BrAC to the outpatient environment where naturalistic drinking occurs.

An Experimental Trial Exploring the Impact of Continuous Transdermal Alcohol Monitoring upon Alcohol Consumption in a Cohort of Male Students

ObjectiveTo examine the impact of continuous transdermal alcohol monitoring upon alcohol consumption in male students at a Scottish university.MethodUsing a within-subject mixed-methods design, 60 male university students were randomly allocated into three experimental conditions using AUDIT score stratified sampling. Participants in Conditions A and B were asked not to consume alcohol for a 14-day period, with those in Condition A additionally being required to wear a continuous transdermal alcohol monitoring anklet. Condition C participants wore an anklet and were asked to continue consuming alcohol as normal. Alcohol consumption was measured through alcohol timeline follow-back, and using data collected from the anklets where available. Diaries and focus groups explored participants’ experiences of the trial.ResultsAlcohol consumption during the 14-day trial decreased significantly for participants in Conditions A and B, but not in C. There was no significant relative difference in units of alcohol consumed between Conditions A and B, but significantly fewer participants in Condition A drank alcohol than in Condition B. Possible reasons for this difference identified from the focus groups and diaries included the anklet acting as a reminder of commitment to the study (and the agreement to sobriety), participants feeling under surveillance, and the use of the anklet as a tool to resist social pressure to consume alcohol.ConclusionsThe study provided experience in using continuous transdermal alcohol monitors in an experimental context, and demonstrated ways in which the technology may be supportive in facilitating sobriety. Results from the study have been used to design a research project using continuous transdermal alcohol monitors with ex-offenders who recognise a link between their alcohol consumption and offending behaviour.

Psoriasis and alcohol: is cutaneous ethanol one of the missing links?

Many exogenous factors including excessive alcohol consumption have been associated with psoriasis, but the underlying mechanisms still remain elusive. Drinking worsens therapeutic compliance, and decreases the efficacy and increases the toxicity of systemic antipsoriatic treatments. Excess alcohol intake results in compromised immunity and increased risk of infections, but alcohol can induce proinflammatory cytokine production in various cell types and can increase mitogen-derived lymphocyte proliferation and lymphocyte activation. As we have previously reported, alcohol and one of its metabolites, acetone, induce keratinocyte proliferation and increase the mRNA levels of genes characteristic for proliferating keratinocytes, such as alpha5 integrin, cyclin D1 and keratinocyte growth factor receptor. Recently the correlation between blood and skin ethanol levels in humans was determined by a transdermal alcohol monitoring device, against the 'gold standard' breath alcohol readings. Based on transdermal alcohol measurements it can be concluded that cutaneous alcohol concentrations can reach levels that induce proinflammatory cytokine production and lymphocyte and keratinocyte proliferation in vitro. It is expected that the development of methodologies measuring transdermal ethanol will provide additional tools to evaluate how alcohol influences skin physiology and different dermatological conditions including psoriasis. Our review focuses on the possible link between alcohol misuse and psoriasis, particularly on the possible role of cutaneous ethanol in precipitating the disease.