Low-Cost Contingency Management for Smoking Cessation
Initial Award Abstract
Cigarette smoking is the major preventable cause of death in the United States. It has been estimated that more than 430,000 deaths occur each year in this country as a result of tobacco use. The decline in the prevalence of smoking in the U.S. during the 1980s and 1990s has not continued in recent years. Although millions of Americans have quit smoking, approximately one in four continue to smoke. The rate of cigarette smoking is much higher among veterans than in California’s population at large. Most smokers who quit return to smoking within three months of their quit date. The content areas of counseling that are significantly associated with cessation include in-treatment social support, extra-treatment social support, problem solving (including skills training), and aversive smoking procedures. However, we still do not understand exactly the process by which these treatment components work and there has not been much innovation in developing new behavioral cessation treatments in the past 15 years. There is a clear need to develop more effective methods of treating nicotine addiction, both in the general population of smokers as well as in special populations of smokers (i.e., women, psychiatric patients, homeless, and drug addicts).
Contingency management as a treatment for substance use disorders involves the use of tangible rewards for confirmed abstinence. There is preliminary evidence that contingency management shows promise as a smoking cessation intervention. An innovative low-cost form of contingency management has been developed in which participants receive the chance to draw vouchers from a fish bowl depending on biological verification of abstinence from tobacco. The vouchers can be redeemed for prizes of varying value. This form of contingency management has been shown to be effective in the treatment of a variety of substance use disorders, but has not been investigated in a clinical trial focusing on smoking cessation.
Therefore, the primary purpose of the proposed study will be to investigate the effectiveness of this low-cost prize-based contingency management intervention for smoking cessation. We will enroll 240 current smokers into the study. The participants in Study Arm 1 will also receive the contingency management intervention for eight weeks. Participants in Study Arm 2 will participate in the same biological assessments of smoking status but will not participate in the contingency management intervention. Subjects in both groups will receive brief counseling for smoking cessation and nicotine replacement therapy. The brief counseling will involve two 60-minute individual sessions scheduled one week apart and three follow-up phone calls at weeks 3, 4, and 6. Outcomes for the two treatment conditions will include biochemically-confirmed smoking status at 3 months (end of treatment), and at 6- and 12-month follow-up. |