TRIS: Contingency Management App for Alcohol Use Disorder

A total of 130 adults with Alcohol Use Disorder (AUD) from two public outpatient clinics in São Paulo, Brazil, will be randomized (1:1) to the experimental or control group. The experimental group will receive standard outpatient treatment plus 12 weeks of remote Contingency Management (CM) delivered through the TRIS mobile application. Participants will submit three daily breath alcohol concentration (BrAC) samples at 1:00 p.m., 5:00 p.m., and 9:00 p.m. using a BACtrack Bluetooth breathalyzer connected to the app. Financial incentives will be provided when all three daily samples are submitted on time and are alcohol-negative (BrAC = 0.00). Incentives begin at R$5.00 per day and increase by R$2.00 for each consecutive day of verified abstinence, up to a maximum of R$15.00 per day. Missed or alcohol-positive samples reset the incentive value to R$5.00 on the next eligible day. Incentives will be redeemed via PIX transfer. The control group will receive standard outpatient treatment and will also use the TRIS application and BACtrack breathalyzer to submit three daily BrAC samples but will not receive contingency management incentives. The primary outcome is the number of biochemically verified days of alcohol abstinence during the 12-week intervention. Secondary outcomes include days without heavy alcohol use, treatment adherence, usability and acceptability of the TRIS application, alcohol withdrawal severity, obsessive-compulsive drinking symptoms, alcohol craving, alcohol use severity, quality of life, psychiatric symptoms, disability, and healthcare service utilization. Assessments will be conducted at baseline, weekly during the 12-week intervention, and at follow-up visits scheduled at Weeks 16, 20, and 24.

Inclusion criteria

• Able to read and speak Portuguese.
• Provide signed informed consent.
• Age 18 to 70 years.
• Alcohol consumption within the past month.
• Current diagnosis of Alcohol Use Disorder (AUD).
• Seeking treatment for AUD at AME Vila Maria or Instituto Perdizes.
• Breath alcohol concentration (BrAC) of 0.00 at the time of consent.
• Own and be able to operate a smartphone with an active mobile service plan.
• Smartphone compatible with the Bluetooth frequency required for the BACtrack breathalyzer.

Exclusion criteria

• Crack cocaine use within the past 90 days.
• Any seizure episode within the past 12 months.
• Diagnosis of a psychotic disorder (DSM-5).
• Suicide attempt within the past two years.
• Any medical or psychiatric condition that may compromise safe participation, as determined by the study medical director.