Less is more is a study using biosensors and gamification of drinking control reduction to reduce participant alcohol intake. The study seeks to develop new forms of interventions for community clinics and generate accessible alcohol reduction programs for high-risk drinkers.


Alcohol misuse in people living with HIV (PLWH) is a public health issue given relationships to cognitive and physical effects, which may accelerate HIV progression, increase transmission and hasten comorbidities. In this project, we will implement several key innovations to extend use of Contingency Management (CM) to facilitate alcohol use abstention and reduction among PLWH. Specifically, we will address feasibility concerns with an eye toward subsequent research using implementation science methods in community health centers and clinics. Our approach to extending CM will marshal gaming capabilities, alcohol biosensors deemed acceptable and usable by study participants, and gamification to engage participants through social connections and friendly competition.

The proposed research will investigate

  • (1) Understand which baseline risk factors (e.g., current drinking severity, cognition) are predictors of failure to abstain or moderate drinking.
  • (2) Develop and evaluate the acceptability and preliminary efficacy of gamified CM, compared to CM with intermittent reinforcement only, and a non-contingent control condition.
  • (3) Drinking reduction with CM will be tested as a predictor of cognitive, HIV and bio-outcomes. medium effects in CM responders

Less is more hypotheses

  • (1) CM will produce large effect increases in percent days abstinent among PLWH. Baseline AUDIT score, lifetime heaviest drinking day and poorer executive function will predict failure to abstain/reduce.
  • (2) Gamified CM will have significantly greater acceptability than non-gamified and control; medium effect advantages in percent days abstinent over control, small effect advantages over non-gamified CM.
  • (3) Drinking reduction will predict enhanced fluid cognition, reduced HIV viral load, lower systemic inflammation (IL6, TNF alpha) with small effects in the full sample and medium effects in CM responders.